INTRODUCTION

Lumbar puncture also known as a spinal tap, is a medical

procedure in which a needle is inserted into the spinal canal ,
most commonly to collect cerebrospinal (CSF) for diagnostic
test. The main reason for a lumbar puncture is to help
diagnose diseases of the central nervous system, including the
brain and spine. Example of these conditions include meningitis
and subarachnoid hemorrhage.

ANATOMY OF SPINE

 The thoracic area consist of 12 vertebrae in the

chest area.
 The lumbar area consist of 5 vertebrae in the
lower back area.
 The sacrum area has 5 fused, small fused vertebrae
.
 The 4 coccygeal vertebrae fuse to form one bone ,
are called coccyx or tailbone.
 The spinal cord, major part of the central nervous
system, is located in the vertebral canal and
reaches from the base of the skull to the upper part
of the back . The bones of the spine and a sac
containing cerebrospinal fluid surround it .The
spinal cord carries sense and movement signal to
and from the brain and controls body.
STRUCTURE OF VERTEBRAL COLUMN
 DEFINITION

 Lumbar puncture (spinal tap) is performed in your lower

back , region .During lumbar puncture , a needle is
 inserted between two lumbar bones (vertebrae) to
remove a sample of cerebrospinal fluid –the fluid that
surrounds your brain and spinal cord to protect them from
inury.
 A lumbar puncture can help diagnose serious infection,
such as meningitis other disorder of the nervous
syst,such as Guillain-Barre syndrome and cancer of the
brain or spinal cord . Sometime doctors use lumbar
puncture to inject anaesthetic medication or
chemotherapy drugs into the cerebrospinal fluid.

INDICATION OF LUMBAR PUNCTURE

 Lumbar puncture done for :-

 Collect CSF for laboratory analysis .
 Measure the pressure of your cerebrospinal fluid.
 Inject spinal anasthetics ,chemotherapy drugs or other
medication.
 Inject dye (myelography) or radioactive substances into CSF
to make diagnostic images of the fluid’s flow.

 To obtain CSF for the diagnosis of :-

 Meningitis.
 Meningoencephalitis.
 Malignancy- diagnosis and treatment.
 Serious bacterial fungal, and viral infection , including
meningitis.

LUMBAR PUNCTURE CONTRAINDICATIONS

 Unstable patient with cardiovascular or respiratory

instability.
 Localized skin / soft tissue infection over puncture site.
 Recent history of seizure.
 Abnormal respiratory pattern.
 Focal neurological signs.

RISK FACTORS
 A small amount of CSF can leak from the needle
insertion site .The can leak from the needle insertion
site. This can cause headache after the procedure . If
can there is a persistent leak the headache can be
severe.
 There is slight risk of infection because the needle
breaks the skin’s surface , providing a possible portal
of entry for bacteria.
 A temporary pain or numbness to the legs or lower
back pain may be experienced.
 There is a risk of bleeding in the spinal canal .

TECHNIQUE OF LUMBAR PUNCTURE

 Use smallest possible gauge(20/22).
 Prefer atraumatic rather than cutting needle.
 1.5 in for <1 yr .
 2.5 in for 1 year to middle childhood .
 3.5 in for older children and adolstscen .
 Larger for large adolescents.

ARTICLES FOR LUMBAR PUNCTURE

 A sterile tray containing with :-

 Anesthetics such as :
 Topical – zylocaine cream
 Lidocaine 1% with 25 gauze needle and syringe
 Povidine-iodine solution & sponge
  Sterile drapes , gauze and gloves.
 Manometer spinal needle, usually22 gauze.
 Specimen bottles to collect the sample .

PATIENT PREPARATION

 Obtain a written consent for the procedure.

 Explain the procedure to the patient.
 Determine whether patient have any doubts or
misconception.
 Reassure the patient.
 Plan to spend at least two hours at the hospital on a
day of procedure.
 Provide loose fiting clothing to increase the comfort of
the patient .
 Advice patient need to lie flat following the lumbar
puncturefor a minimumof 30 min to promote clotting at
the site of the puncture.

POSITION OF PATIENT

 The patient is placed in lateral recumbent position with the

hips, knees and chin flexed toward the chest so as to open
the inter laminar spaces or interspinous distance .
 A pillow may used to support the head.
 Lateral decubitus position –flex spine without comprising
airway. Keep alignment of feet , knees and hip, position of
head to left .
PROCEDURE

 Assess the
gerenal condition of the patient,and check all the laboratory
investigation ,prepare all the article .
 Wash hand .
 Wear gloves and maintain sterile field.
 Performed with the patient in the lateral recumbent position
 Spinal needle entering the subarachnoid space at this point
are well below the termination of the spinal cord .
 Apply topical anesthetic 30-45 min prior to procedure.
 Spinal cord end at L1-L2 so sites for puncture are located at
L3-L4 or L4- L5.
 Provide position to the patient (lateral decubitus position).
 Clean skin with antiseptic solution ( povidone iodine) from
puncture the site and allow to dry.
 Drape below the patient around the site .
 Encourage patient to relax & to breath normally .
 Insert spinal needle with stylet with bevel up to keep
cutting edge parallel with nerve and ligament fibre.
 A pop of sudden decrease in resistance indicate that
ligamentous flavum and dura are punctured.
 Remove stylet and check for flow of spinal fluid .
 If no fluid,then:
 Rotate needle 90.
 Reinsert stylet and advance needle slowly checking
frequently for CSF .
 If bony resistance is felt immediately then you are not in the
spinal interspace.
 If bloody fluid that does not clear or that clots result ,then
withdraw needle and reattempt at a different interspace.
 When there is realiable flow of CSF attach a 3 way tap if
measuring pressure or collect sample directly into the
specimen containers.
 Collect CSF 10 to20 drops (5 to 10 drop for children).
 Collect 1ml of CSF in each 3 vial for:-1vial for culture or
gram stain,2vial for glucose and protein , 3 vial for cell count
& differential, if extra CSF desired for other lab test.
 After collection , remove the needle and stylet together.
 Apply a sterile dressing to the puncture site.
 Sent specimen to laboratory as soon as possible.

MANOMETERY

 Pressure can be only be accurately measured in lateral

decubitus position and in the relaxed patient .
 Attach manometer with a 3-way stopclock when free
flow of CSF is obtained.
 Read column when highest level is achieved and
respiratory variation is noticed.

AFTER CARE
 Advice patient to flat remain on exam table for a
minimum of 30 min to help prevent any leakage of
spinal fluid after the procedure.
 Encourage the patient to drink extra fluid while you
recover and for the next two or three days.
 A headache following spinal tap occurs in upto 20 % of
patients .it typically occurs upon standing and is
relieved by lying down.
 Advice patient to avoid heavy lifting for two to three
days following procedure.
 Hand wash or remove articles.
 Recording and reporting.

COMPLICATION

 Headache.
 Back pain.
 Bleeding or fluid leakage.
 Infection .
 Nerve trauma.

SUMMARY
So today we have discuss the topic lumbar puncture
under we have dicussed :

 Introduction , Anatomy of spine, Definition ,

Indication, Risk factor, Contraindication,
Preparation of patient, Procedure, After care of
patient.
 CONCLUSION

Lumbar puncture is the process of insertion of a needle into

a lumbar region of the spine so that the cerebro spinal fluid
can be withdrawn for a laboratory investigation to diagnose
the disease . It is a common procedure in order to detect
any bacterial ,viral infection causes the disease .
 REFRENCES

 Plavsic, S.k. (2017) . urgent in medical practice.

New Delhi ;jaypee Brothers Medical.

 K.Christopher & Henretig F.M.(2008) ,Textbook of

Medical Surgical Nursing,Lippincort William &
Wilkins.
 Brunner & Suddarth , Textbook of Medical Surgical
Nursing, Published by Wolter Kluwer (India)
Pvt.Ltd, New Delhi . Page No.-1854 -1856.
 Joyce .M. Black, Textbook of Medical Surgical
Nursing, 8 edition, Published by Elsevier.
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