The Lumbar Puncture Bookmark ShareA lumbar punctures is a procedure in which a needle is used to access the subarachnoid space. This may be used to collect cerebrospinal fluid (CSF) for diagnostic purposes, or therapeutic purposes in order to deliver drugs. CSF Analysis Guide***IndicationsCSF analysis / pressure, intrathecal medicationsContraindicationsRaised ICP, infected tissue over insertion site, coagulopathyEquipment & PreparationSterile GlovesStrile GownGogglesMaskMarking PenDecontaminantE.g. chlorhexidine or povidone-iodineSterile FieldE.g. large dressing packFenestrated drapeLumbar Puncture NeedleWith styletUse an atraumatic needle where possibleLumbar Puncture Set3-way tap, spinal manometerCSF Specimen TubesLocal Anaesthetic1% Lignocaine in a 5mL syringe with long needleDressingSterile impermeable adhesive dressingExit StrategySharps containerDocumentationTest request form, patient labelsIdentifying the Insertion SitePositioningSitting or foetal positionIdentify the L4/L5 Intervertebral SpaceIn the midline between iliac crestsInsertionExplain the procedure and ask for patient's consentIt is important to continually communicate with the patient and tell them what you are doingPositioningSitting or lateral foetal positionIdentify the L4/L5 Intervertebral SpaceIn the midline between iliac crestsMark the Desired SiteL3/L4, L4/L5, L5/S1Using the marking penPrepare Sterile FieldDon goggles and maskScrub, sterile glove and gownPrepare Sterile EquipmentPlace everything in the order it will be usedPrepare the AreaDecontaminate with chlorhexidine or povidone-iodineApply the fenestrated drapeReposition the PatientTo ensure maximum flexion of the lumbar spineIdentify the Site AgainMaintaining sterile conditionsInject Local AnaestheticMake a small wheal over the insertion siteInsert the Needle into the MidlineSlowly, with bevel up and facing slightly superiorlyA ‘pop' may be felt on entry to the duraRemove the StyletLook for CSF drainageIf required - replace the stylet, remove the needle slightly and readvance at a different angleMeasure Opening PressureAttach the three-way tap and manometerCollect CSFDrain three 2mL samples into specimen containersReinsert the styletRemove the NeedleLook for CSF leakageApply the DressingClean UpDispose of sharps and other wasteRemove gloves and wash handsProcessingLabel the collection tubes and send to the labBed RestCheck local guidelines for bed rest post LPComplicationsInadequate SampleBlood-stained, insufficient volumeHeadacheMay occur hours or days post LPBack PainBleedingAround site or into the subarachnoid spaceCerebral HerniationDon't perform LP if raised intracranial pressureInfectionMeningitis, abscessOn this page: Equipment & PreparationIdentifying the Insertion SiteInsertionComplications