95: Lumbar Puncture (Perform)

Published on 07/03/2015 by admin

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Last modified 07/03/2015

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Lumbar Puncture (Perform)

A lumbar puncture is performed for access to the subarachnoid space to obtain a cerebrospinal fluid sample, measure cerebrospinal fluid pressure, drain cerebrospinal fluid, infuse medications or contrast agents, or place a cerebrospinal fluid drainage catheter.1–3^,⁷

PREREQUISITE NURSING KNOWLEDGE

• Knowledge of the anatomy and physiology of the vertebral column, spinal meninges, and cerebrospinal fluid (CSF) circulation, including the location of the lumbar cistern, is needed.

• Technical and clinical competence in performing lumbar punctures (LPs) is necessary.

• Knowledge of sterile technique is needed.

• The presence of meningeal irritation caused by either infectious meningitis or subarachnoid hemorrhage may promote discomfort when the patient is placed in the flexed, lateral decubitus position for the LP.3–5^,¹⁷

• Computed tomography (CT) scan or magnetic resonance imaging (MRI) supersedes the routine use of LP for many diagnoses.⁵^,⁷^,¹⁸^,²⁸

• Indications for LP include the following ⁴^,⁵^,¹⁸^,²⁸:

Suspected central nervous system (CNS) infection

Clinical examination results suggestive of subarachnoid hemorrhage accompanied by negative CT scan findings

Suspected Guillain-Barré syndrome

Suspected multiple sclerosis

Intrathecal administration of medications

Imaging procedures that require infusion of contrast agents

Measurement of CSF pressure

CSF drainage in hydrocephalus, pseudotumor cerebri, or CSF fistula

• Contraindications for LP include the following ³^,¹⁸^,²⁸^,²⁹:

Increased intracranial pressure with mass effect

Superficial skin infection localized to the site of entry

Bleeding diathesis (relative contraindication)

Platelet count less than 50,000/mm ³

International normalized ratio (INR) greater than 1.5

Anticoagulation therapy (e.g., heparin, warfarin)

• Normal CSF values include the following ¹⁸^,²⁰^,²³^,²⁸:

Opening pressure, 0 to 15 mm Hg

White blood cell count, less than 5/mm

Glucose, 60% to 70% of serum blood glucose

Protein, 15 to 45 mg/dL

Clear colorless appearance

Negative culture results

• Recommended CSF tests include the following ¹⁸^,²⁰^,²³^,²⁸

Tube #1: Biochemistry:

Protein electrophoresis (if clinically indicated)

Tube #2: Bacteriology:

Bacterial culture

Fungal culture (if clinically indicated); requires larger volume

Tuberculosis culture (if clinically indicated); requires larger volume

Tube #3: Hematology:

Tube #4: Optional studies as indicated:

Venereal disease research laboratory (VDRL) test

Oligoclonal bands

EQUIPMENT

• Sterile gloves, caps, masks with eye shields or goggles, and sterile gowns

• Sterile drapes

• Sterile gauze pads

• Antiseptic solution

• Fenestrated drape

• Manometer with three-way stopcock

• Lidocaine, 1% to 2% (without epinephrine)

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