Lumbar Puncture

Published on 22/03/2015 by admin

Filed under Critical Care Medicine

Last modified 22/03/2015

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W18 Lumbar Puncture

Sarice L. Bassin, Thomas P. Bleck

Before Procedure

Indications

• Suspicion of central nervous system (CNS) infection

• Suspicion of subarachnoid hemorrhage

• The need to obtain cerebrospinal fluid to diagnose other inflammatory or degenerative CNS diseases

• Reduction of cerebrospinal fluid (CSF) pressure in pseudotumor cerebri

Contraindications

• Intracranial or spinous (especially intramedullary) mass (e.g., tumor, abscess). If there is concern, an imaging study should be performed before the procedure. A rapid decrease in intracranial pressure from withdrawal of CSF could precipitate herniation or worsening of spinal cord function if a mass lesion is present.

• Overlying skin infection

• Lumbar spine disease

• Coagulopathy and/or thrombocytopenia, because an epidural hematoma can develop at the puncture site. Fresh frozen plasma and platelets should be infused to correct hematologic abnormalities before the procedure. If a coagulopathy is discovered after the procedure, therapy should still be given, because bleeding can occur for many hours.

• If a lumbar puncture is being performed to evaluate a patient for aneurysmal subarachnoid hemorrhage, withdraw the smallest possible amount of CSF to obtain the necessary laboratory tests. Reducing the CSF pressure could precipitate rebleeding.

• Uncooperative patient

Equipment

• Lumbar puncture tray or individual components (see later)

• Chlorhexidine or povidone-iodine prepping solution

• Sterile drape with central opening

• 1% Lidocaine and a syringe with 25- and 22-gauge needles for local anesthesia

• 20- or 22-gauge spinal needle

• Tubes for CSF collection

Anatomy

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