Lumbar Puncture Daryl P Lofaso MEd RRT Indications for Lumbar Puncture To obtain CSF for Laboratory Examination Administer Medications into subarachnoid space Perform Myelography Measure ICP ID: 1046338
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1. CSI 201 - Skills Lab 2Lumbar PunctureDaryl P. Lofaso, M.Ed, RRT
2. Indications for Lumbar PunctureTo obtain CSF for Laboratory ExaminationAdminister Medications into subarachnoid spacePerform MyelographyMeasure ICPDx CNS infections and Inflammatory Diseases
3. ContraindicationsInfections at puncture siteSuspected CNS mass lesionIncreased ICP (relative)Coagulation disorder (relative)
4. Lumbar Puncture ChecklistCheck the indicationsKnow the risks and how to deal with serious complicationsExplain the issues to the patientCheck for allergy to lidocaine or iodineConsider bleeding tendency / risks
5. Lumbar Puncture EquipmentConsent form (Signed) Lab request forms and specimen bottlesSterile Gloves, Sterile Gown, Mask & Eye protectionLocal anestheticLP Tray
6. Lumbar PunctureWhat structures or layers with the needle pass through before reaching the subarahnoid space?SkinSuperficial fasciaSuperspinous ligamentInterspinous ligamentLigamentum flavumEpidural space containing fatty areolar tissue and the internal vertebral venous plexusDura materArachnoid materSubarachniod space
7. Invasive/Non-Invasive Procedure ConsentsDate/Time of consentIndicationsAlternative treatmentRisk/BenefitsDocumentation that all questions have been answeredSignature of patient or authorized representative before procedure performed & appropriate witness – Date/Time
8. Test CSFAppearanceProteinSugarSerologyCell CountBacterial or Fungal Cultures
9. Helpful Hints What is the most important step before performing a Lumbar Puncture?Answer: Positioning the Patient
10. Culture TubesTube 1: Gram stain, (AFB, fungal)Tube 2: Glucose and ProteinTube 3: Cell count (RBC, WBC with differentials)Tube 4: Hold for possible (VDRL, India ink, electrophoresis, antigen panel)
11. Complications to LPSpinal HeadacheTraumaHerniationInfectionHemorrhageBloody Tap
12. Invasive/Non-Invasive Procedure NoteProper Patient IdentificationSite VerificationPre / Post Medication for pain controlIntra / Post procedure monitoringComplications, if anyManagement of Complications
13. Standard PrecautionsAll Patients are potentially infectious.Good Handwashing is the key to reducing nosocomial infectionsWash before and after patient contactWear a mask, eye protection, face shield and gown when needed