LUMBAR PUNCTURE

DEFINITION:

Lumbar Puncture is the insertion of sterile needle into the sub-arachnoid space of the spinal canal, usually between the third and fourth vertebra, to reach the cerebral spinal fluid.

This procedure requires sterile technique and careful client positioning. It is performed therapeutically to administer drugs or anaesthetics and to relieve intra-cranial pressure.

PURPOSE:

1. To determine the pressure of the cerebral spinal fluid (CSF)
2. To detect increased intra-cranial pressure (ICP)
3. To detect presence of blood in the cerebral spinal fluid, this indicates cerebral haemorrhage
4. To obtain cerebral spinal fluid specimen for laboratory analysis

PRE PROCEDURE CARE:

1. Reinforce doctor's explanation to client and significant others to the get cooperation from the client
2. Check if consent has been properly secured and attached to chart to prevent legal implications
3. Verify from doctor place for performing the procedure to facilitate the procedure
4. Prepare equipment needed to get the requirement ready
5. Screen the client properly to provide privacy for the client
6. Ask the client to empty the bladder to prevent complications

POST CARE:

1. Instruct the patient to lie flat for at least 6 hours to reduce chance of headache 
2. Monitor the patient carefully following the procedure. Adverse reactions including headache, vertigo, syncope, nausea, tinnitus, respiratory distress, change in vital signs and fever should be reported to the professional nurse or doctor to detect the abnormalities if any
3. Give the patient increased fluids for at least 24 hours after the procedure to prevent dehydration
4. Ensure the comfort and safety of the patient to promote comfort of the patient
5. Record the procedure in the client's chart to provide baseline data

THE NORMAL RESULTS OF CSF:

• Protein: 15-45 mg/dL
• Glucose: 50-80 mg/dL
• White Blood Cell: < 5 mm3
• Red Blood Cell: 0-5
• Opening Pressure: 5-20 cm
• Clarity, Colour: Clear and colourless.