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Its a Saturday and because she has no class, Giselle decided that it

would be the best time to take a break from all her nursing school
requirements and just have a chill day. After cooking something to
eat, she sits on her comfy couch and surfs the television for
something to watch. After changing from one channel to another,
she finally settles down to a drama movie.
The movie has got her so engrossed. She wipes a single tear
escaping from her right eye as she watches the doctor tell the main
character about the probability of her having brain cancer and that
she needs to undergo a spinal tap procedure.
As the character later gets placed on a side lying position, Giselle
tries to recall everything they have discussed in the classroom
about the procedure.
How is it done again? What are the things that need to be
considered when performing the procedure? she asks herself as
she continues to watch as a needle gets inserted at the lower back
of the main character.
Overview of the Lumbar Puncture Procedure
Lumbar puncture is often performed in the emergency department to obtain
information about the cerebrospinal fluid (CSF). Also known as spinal tap,
this procedure can help diagnose serious and sometimes life-threatening
infections, including meningitis; disorders of the central nervous system, such
as Guillain-Barre syndrome and multiple sclerosis; or cancers of the brain
or spinal cord. At other times, doctors use lumbar puncture to inject anesthetic
medications or chemotherapy drugs into the cerebrospinal fluid.
Lumbar puncture is performed in the patients lower back, specifically in the
lumbar region. During this procedure, a needle is inserted between two
vertebrae to remove a sample of cerebrospinal fluid, which surrounds the
brain and spinal cord to protect them from injury.

This procedure should be performed only after a neurologic examination but

should never delay potentially life-saving interventions, which includes the
administration of antibiotics and steroids to patients with suspected bacterial

Indications for this procedure

Lumbar puncture may be done to:

Collect cerebrospinal fluid for laboratory analysis

Measure the pressure of your cerebrospinal fluid
Inject spinal anesthetics, chemotherapy drugs or other
Inject dye (myelography) or radioactive substances
(cisternography) into cerebrospinal fluid to make diagnostic
images of the fluids flow
Information gathered from a lumbar puncture can help diagnose:

Serious bacterial, fungal and viral infections, including

meningitis, encephalitis and syphilis
Bleeding around the brain (subarachnoid hemorrhage)
Certain cancers involving the brain or spinal cord
Certain inflammatory conditions of the nervous system, such
as multiple sclerosis and Guillain-Barre syndrome
However, just like any other procedure, lumbar puncture comes with risks and
precautions. Risks include:

Post-lumbar puncture headache, which may be due to a leak of

fluid into nearby tissues
Back discomfort or pain, which might radiate down the back of
your legs.
Bleeding, which may occur near the puncture site or, rarely,
into the epidural space.
Brainstem herniation, since increased intracranial pressure,
due to a brain tumor or other space-occupying lesion, can lead to
compression of the brainstem after a sample of cerebrospinal
fluid is removed.
Before the lumbar puncture is done, certain preparatory procedures may be

A physical examination may be done as well as a complete

health history may be obtained including a review of the
medications that the patient is receiving
Blood tests may be ordered if the patient has bleeding/clotting
A CT scan may be performed to determine if the patients has
any abnormal swelling in or around your brain
The procedure itself
These are what happens when a spinal tap is done:
1. A local anesthetic is injected into your lower back to numb the
puncture site before the needle is inserted. The local anesthetic
will sting briefly as its injected.
2. A thin, hollow needle is inserted between the two lower
vertebrae (lumbar region), through the spinal membrane (dura)
and into the spinal canal. You may feel pressure in your back
during this part of the procedure.
3. Once the needle is in place, you may be asked to change your
position slightly.
4. The cerebrospinal fluid pressure is measured, a small amount
of fluid is withdrawn, and the pressure is measured again. If
needed, a drug or substance is injected.
5. The needle is removed and the puncture site is covered with a

The procedure may last up to about 45 minutes. After the fluid is obtained, it
will be sent to the laboratory where it will be thoroughly examined including its
general appearance, Protein (total protein and the presence of certain
proteins), White blood cells, Sugar (glucose), Microorganisms, and Cancer
cells.Laboratory results are ten combined with information obtained during the
test, such as spinal fluid pressure, to help establish a possible diagnosis.