Assisting Lumbar

Puncture

By:
Bonifacio P. Marilao Jr.
Kirstine Anne Camille F. Nuez
 ASSISTING IN LUMBAR PUNCTURE
Objectives:
At the end of 8 hours class discussion and demonstration, the level III
nursing students will be able to

1. Define the following terms:

1.1 Subarachnoid space
1.2 Cerebrospinal fluid
1.3 Intracranial pressure
1.4 Foramen magnum
1.5 Herniation
1.6 Lumbar space
1.7 Lumbar puncture
2. Review the anatomy and physiology of the organ system involve in
lumbar puncture.
3. State the purposes of lumbar puncture.
3.1 Diagnostic purposes
3.2 Therapeutic purposes
4. Discuss the indications and contraindications of lumbar puncture
5. Identify the site and position of the patient during the procedure.
6. Enumerate the possible complications the patient may experience
after the lumbar puncture.
7. Interpret laboratory results for the specimen taken in the lumbar
puncture.
8. Review guidelines for lumbar puncture.
9. Describe the nursing responsibilities before, during, and after lumbar
puncture.
10. Demonstrate beginning skills in assisting the physician in lumbar
puncture.
Subarachnoid space

 the space between the arachnoids mater and pia

mater which is normally containing a potential space
containing a very small amount of serous fluid.
Cerebrospinal fluid

- Bathes the brain and spinal cord providing a

protective cushion around the CNS
- It fills brain ventricles, the central canal of the spinal
cord and the subarachnoid space.
Intracranial Pressure

 The pressure inside the skull and thus in the brain tissue
cerebrospinal spinal fluid. The normal intracranial
pressure is 8-15mmHg
Foramen magnum

- opening of the skull through which the spinal cord

joins the brain, spinal cord enters spinal column.
Herniation

 A protrusion of an organ through connective or

through a wall in which it is normally closed
Lumbar puncture (spinal tap)
- a medical procedure which involves withdrawing
Cerebrospinal fluid by the insertion of a hollow
spinal needle.
- 1-10 ml CSF to be withdrawn
- lasts for 15-30 minutes
ANATOMY AND PHYSIOLOGY OF SPINAL
CORD
PURPOSES OF LUMBAR PUNCTURE:
Diagnostic purposes:
 To measure and reduce CSF pressure
 To detect spinal subarachnoid block
 To identify extent of infarction/stroke
 To obtain CSF for visual and laboratory examination

Therapeutic purposes:
 To introduce therapeutic agents
 To introduce the spinal anesthesia for surgery
INDICATIONS:

 Encephalitis
 Hydrocephalus
 Polio
 Multiple sclerosis
 Suspected meningitis
 Subarachnoid hemorrhage
CONTRAINDICATIONS:

 Idiopathic increase intracranial pressure

 Agitated patient
 Patient with papilledema
 Patient with bleeding disorder
 Chronic back pain
SITE AND POSITION OF THE PATIENT
DURING THE PROCEDURE:
SITE
 Between L3 and L4 or L5
POSITION
 Lateral decubitus or recumbent or sitting
upright position
POSSIBLE COMPLICATIONS:

 Post-LP headache
 Infection
 Bleeding
 Cerebral herniation
 Minor neurologic symptoms such as radicular pain or
numbness
 Late onset of epidermoid tumors of thecal sac
LABORATORY RESULTS:
NORMAL RESULT
 CSF pressure: 50-180 mmH2
 Glucose: 40-85 mg/dL
 Protein: 15-50 mg/dL
 Leukocytes (white blood cells) total less than 5 per mL
 Lymphocytes (specific type of white blood cell): 60-70%
 Monocytes (a kind of white blood cell): 30-50%
 Neutrophils (another type of white blood cell): none
 Normally, there are no red blood cells in the CSF unless the needle
passes though a blood vessel on route to the CSF. If this is the case,
there should be more red blood cells in the first tube collected than
in the last.
ABNORMAL RESULT
Cause Appearance Polymorpho Lymphocy Protein Glucose
nuclear tes
Leukocytes
Pyogenic Yellowish, Markedly Slightly Markedly Decrease
bacterial turbid increased increased increased d
meningitis or Normal

Viral Clear fluid Slightly Markedly Slightly Normal

meningitis increased or increased increased
Normal or Normal

Tuberculo Yellowish Slightly Markedly Increased Decrease

us and viscous increased or increased d
meningitis Normal

Fungal Yellowish Slightly Markedly Slightly Normal or

meningitis and viscous increased or increased increased decrease
Normal or Normal d
GUIDELINES FOR LUMBAR PUNCTURE:
 Lateral decubitus or recumbent position must be maintained with the
back to the edge of the bed
 Avoid sudden movement that can cause traumatic blood tap
 A small pillow may be used to maintain the patient’s head and spine
in a horizontal position
 The patient must relax and breath normally, hypoventilation may
lower and elevate pressure thus, altering CSF analysis
 Encourage patient to increase fluid intake to replace CSF withdrawn
NURSING RESPONSIBILITIES:
Before:
 Informed consent must be signed
 Assemble necessary equipments
 Explain the procedure to the patient, its importance, and the
pressure sensation to be experienced
 Position the patient in a lateral decubitus position
During:

 Observe patient’s color, respiration, and pulse

 Provide privacy
 After:
 Encourage the patient to drink plenty of water
 Maintain supine position for two hours
 Take vital signs every 15 minutes for one hour and evaluate patient
 Check patient’s back and legs for numbness and pain
 Do after care of the equipment
 Record the amount of fluid withdrawn and nature of fluid and
viscosity
MANOMETER
THE END