lumbar punture
DESCRIPTION
lumbar puncture for nursesTRANSCRIPT
![Page 1: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/1.jpg)
APARNA A1st year MSc Nursing
College Of NursingKottayam
![Page 2: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/2.jpg)
LUMBAR PUNCTURE or SPINAL TAP is carried out by inserting a needle into Lumbar subarachnoid space to withdraw C S F
![Page 3: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/3.jpg)
To obtain C S F for analysis & diagnosis of:◦ Meningitis
◦ Meningoencephalitis
◦ Subarachnoid hemorrhage
◦ Malignancy – diagnosis and treatment
◦ Pseudotumor Cerebri
◦ Other neurologic syndromes
To drain C S F & reduce intracranial space
To instill medications
![Page 4: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/4.jpg)
Increased intracranial pressure ◦ Head CT before study if focal neurologic findings
present to rule out impending cerebral mass herniation
• If platelet count is less than 40,000 and Prothrombin time is less than 50% of control
![Page 5: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/5.jpg)
Hydrocephalus- Enlarged ventricle size & in suspected normal pressure Hydrocephalus
Coma- If C T is negative and I C P increased
Meningitis- Exclude mass lesion & confirm diagnosis
![Page 6: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/6.jpg)
Use smallest possible gauge [20/22]
Prefer atraumatic rather than cutting needle
•1.5 in for < 1 yr•2.5 in for 1 year to middle childhood•3.5 in for older children and adolescents•Larger for large adolescents
![Page 7: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/7.jpg)
Needle is inserted into subarachnoid space through intervertebral space
![Page 8: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/8.jpg)
Spinal cord ends at L1-L2, so sites for puncture are located at L3-L4 or L4-L5
Restrain patient in lateral decubitus position
◦ Maximally flex spine without compromising airway
◦ Keep alignment of feet, knees and hips
◦ Position head to left if right handed or vice versa
![Page 9: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/9.jpg)
•Anesthetic such as:Topical- Zylocaine cream or Lidocaine 1% with 25 gauge needle and syringe
•Povidone-iodine solution & sponge•Drapes, gauze, and bandages•Manometer, stopcock, tubing and
specimen bottles
•Sterile CSF tray with
•Spinal needle
![Page 10: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/10.jpg)
Obtain a written consent for the procedure
Explain the procedure to the patient
Determine whether patient have any doubts or misconceptions
Reassure the patient
Instruct patient to void after procedure
![Page 11: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/11.jpg)
•Position the patient at oneside of edge of bed •Place a small pillow under patient’s head & another between the legs •Assist the patient to maintain position•Encourage patient to relax & to breath normally •Describe the procedure step by
![Page 12: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/12.jpg)
•The physician cleanses the site with antiseptic solution and drapes the site •Local anesthetic is injected to numb the site and a spinal needle is inserted to subarachnoid space with stylet with bevel up to keep cutting edge parallel with nerve and
![Page 13: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/13.jpg)
A specimen of C S F is collected usually in three test tubes
Needle is withdrawn & a small dressing is applied at puncture site
Sent specimen to lab
immediately
![Page 14: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/14.jpg)
Instruct patient to lie on prone for 2 to 3 hours
Monitor patient for any complications
Encourage increased fluid intake
![Page 15: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/15.jpg)
Headache Back pain [Occasionally with short-lived ]◦ Disc herniation if needle advanced too far
Bleeding or fluid leak around spinal cord Infection, pain, hematoma Subarachnoid epidermal cyst Ocular muscle palsy (1%) Nerve Trauma Brainstem herniation
![Page 16: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/16.jpg)
Throbbing bifrontal & occipital headache
Dull and deep in character
Severe on sitting or standing
IT CAN BE AVOIDED BY:
Using small gauge needle
Keep patient prone after procedure for 2 hours, then side-lying for 2-3 hours, then supine or prone for 6 or more hours
![Page 17: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/17.jpg)
Bed rest
Analgesics
Hydration
Epidural blood patch
![Page 18: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/18.jpg)
Clear and colourless
Secreted by choroid plexus
Exists in subarachnoid space
It is about 150-200ml acts as shock absorber transports nutrients
![Page 19: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/19.jpg)
1. If C S F is blood tinged 3 samples has to be collected
2. Uniformly stained SA H
3. CSF clears in 3rd bottle-Traumatic trap
1 2 3
1 2 3
![Page 20: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/20.jpg)
Usually obtained for cell count, culture, glucose and protein testing
R B C and Differential W B C
Bacteriological –Gram stain and culture
Biochemical-Protein[0.15-0.45g/l]
- glucose [0.45-0.70g/l]
![Page 21: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/21.jpg)
SAH : Spectrophotometry Malignant Tumor: Cytology Tuberculosis: Polymerase chain reaction,
Jensen Culture Non-bacterial Infection: Virology, fungal &
parasitic studies Demyelinating Disease: Oligoclonal bands Neurosyphilis: V D R L test Cryptococcus: culture, antigen detection H I V : culture, antigen detection & antiviral
antibodies
![Page 22: Lumbar punture](https://reader034.vdocument.in/reader034/viewer/2022052412/55941acc1a28ab0a2c8b460c/html5/thumbnails/22.jpg)