The Lumbar Puncture

Sterile Gloves

Strile Gown

Goggles

Mask

Marking Pen

Decontaminant

E.g. chlorhexidine or povidone-iodine

Sterile Field

E.g. large dressing pack

Fenestrated drape

Lumbar Puncture Needle

With stylet

Use an atraumatic needle where possible

Lumbar Puncture Set

3-way tap, spinal manometer

CSF Specimen Tubes

Local Anaesthetic

1% Lignocaine in a 5mL syringe with long needle

Dressing

Sterile impermeable adhesive dressing

Exit Strategy

Sharps container

Documentation

Test request form, patient labels

Explain the procedure and ask for patient's consent

It is important to continually communicate with the patient and tell them what you are doing

Mark the Desired Site

L3/L4, L4/L5, L5/S1

Using the marking pen

Prepare Sterile Field

Don goggles and mask

Scrub, sterile glove and gown

Prepare Sterile Equipment

Place everything in the order it will be used

Prepare the Area

Decontaminate with chlorhexidine or povidone-iodine

Apply the fenestrated drape

Reposition the Patient

To ensure maximum flexion of the lumbar spine

Identify the Site Again

Maintaining sterile conditions

Inject Local Anaesthetic

Make a small wheal over the insertion site

Insert the Needle into the Midline

Slowly, with bevel up and facing slightly superiorly

A ‘pop' may be felt on entry to the dura

Remove the Stylet

Look for CSF drainage

If required - replace the stylet, remove the needle slightly and readvance at a different angle

Collect CSF

Drain three 2mL  samples into specimen containers

Reinsert the stylet

Remove the Needle

Look for CSF leakage

Apply the Dressing

Clean Up

Dispose of sharps and other waste

Remove gloves and wash hands

Processing

Label the collection tubes and send to the lab

Bed Rest

Check local guidelines for bed rest post LP

Inadequate Sample

Blood-stained, insufficient volume

Back Pain

Bleeding

Around site or into the subarachnoid space

Infection

Meningitis, abscess