Overview
Lumbar Puncture is a diagnostic and therapeutic procedure used to collect cerebrospinal fluid (CSF) from the subarachnoid space. It is essential for diagnosing various neurological conditions.
Lumbar puncture is crucial for diagnosing meningitis, subarachnoid hemorrhage, and other neurological disorders. It provides direct access to CSF for analysis.
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Indications
Bacterial, viral, fungal
Suspected SAH
CSF analysis
Protein analysis
Pressure measurement
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes patient consent, proper positioning, sterile technique, and equipment setup.Step-by-Step Procedure
Step 1: Patient Preparation
Explain procedure, obtain consent, position patient.
⚠️ Common Mistakes to Avoid:
- Inadequate consent
- Poor positioning
💡 Pro Tip:
Position patient in lateral decubitus or sitting position.
Step 2: Landmark Identification
Identify L3-L4 or L4-L5 interspace.
⚠️ Common Mistakes to Avoid:
- Wrong level
- Poor landmarks
💡 Pro Tip:
Use iliac crest as landmark.
Step 3: Sterile Preparation
Prep and drape sterile field.
⚠️ Common Mistakes to Avoid:
- Inadequate prep
- Contamination
💡 Pro Tip:
Use strict sterile technique.
Step 4: Local Anesthesia
Infiltrate local anesthetic.
⚠️ Common Mistakes to Avoid:
- Inadequate anesthesia
- Wrong technique
💡 Pro Tip:
Use adequate local anesthetic.
Step 5: Needle Insertion
Insert needle with proper technique.
⚠️ Common Mistakes to Avoid:
- Wrong angle
- Multiple attempts
💡 Pro Tip:
Use midline approach.
Step 6: CSF Collection
Collect CSF samples and measure pressure.
⚠️ Common Mistakes to Avoid:
- Inadequate samples
- Wrong pressure
💡 Pro Tip:
Collect adequate volume.
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Post-procedure Care
Post-procedure care involves monitoring for complications, patient education, and specimen handling.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Post-LP headache | 10-30% | Positional headache | Bed rest, hydration | Small needle, proper technique |
| Bleeding | 1-2% | Back pain, neurological symptoms | Imaging, observation | Check coagulation |
| Infection | 0.1-1% | Fever, back pain | Antibiotics | Sterile technique |
| Nerve injury | 0.1-1% | Radicular pain | Observation, pain control | Gentle technique |
Clinical Pearls
Use iliac crest as landmark for L3-L4.
Use small gauge needle to reduce headache.
Measure opening pressure in all cases.
Collect adequate volume for all tests.
Use strict sterile technique.
Position patient properly.
Monitor for complications post-procedure.