Overview
Pediatric Lumbar Puncture is a diagnostic procedure used to obtain cerebrospinal fluid (CSF) for analysis. This procedure is commonly performed to evaluate for meningitis, encephalitis, and other central nervous system disorders in children.
LP is essential for diagnosing central nervous system infections, particularly bacterial meningitis, which can be life-threatening in children. Proper technique is crucial to avoid complications and obtain adequate samples for analysis.
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Indications
Fever with meningeal signs or altered mental status
Altered mental status with fever
Suspected SAH with negative imaging
Suspected GBS for protein analysis
Suspected MS for oligoclonal bands
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
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Pre-procedure Preparation
Preparation includes explaining the procedure to patient and family, ensuring proper patient positioning, gathering necessary equipment, and preparing for potential complications. All team members should understand their roles.Step-by-Step Procedure
Step 1: Patient Preparation
Explain procedure to patient and family. Position patient in lateral decubitus or sitting position. Ensure proper positioning with flexed spine.
⚠️ Common Mistakes to Avoid:
- Inadequate explanation
- Poor positioning
- Insufficient spine flexion
💡 Pro Tip:
Proper positioning is crucial for successful LP - ensure spine is well-flexed.
Step 2: Site Identification
Identify L3-L4 or L4-L5 interspace. Mark site with pen. Clean area with antiseptic solution. Apply sterile drape.
⚠️ Common Mistakes to Avoid:
- Wrong interspace selection
- Insufficient cleaning
- Poor sterile technique
💡 Pro Tip:
L3-L4 is the preferred interspace for pediatric LP.
Step 3: Local Anesthesia
Administer local anesthetic to skin and subcutaneous tissue. Wait 1-2 minutes for effect. Test sensation.
⚠️ Common Mistakes to Avoid:
- Inadequate anesthesia
- Wrong anesthetic dose
- Insufficient wait time
💡 Pro Tip:
Use adequate local anesthetic to minimize patient discomfort.
Step 4: Needle Insertion
Insert spinal needle with stylet in place. Advance slowly with bevel facing up. Feel for "pop" when entering subarachnoid space.
⚠️ Common Mistakes to Avoid:
- Wrong insertion angle
- Rapid advancement
- Failure to feel "pop"
💡 Pro Tip:
Advance slowly and feel for the "pop" when entering the subarachnoid space.
Step 5: CSF Collection
Remove stylet. Collect CSF in sterile tubes. Measure opening pressure if indicated. Send samples for analysis.
⚠️ Common Mistakes to Avoid:
- Contaminated samples
- Inadequate sample volume
- Wrong tube order
💡 Pro Tip:
Collect samples in the correct order: cell count, protein/glucose, culture, special studies.
Step 6: Needle Removal
Replace stylet. Remove needle. Apply pressure to puncture site. Apply bandage. Position patient supine.
⚠️ Common Mistakes to Avoid:
- Removing needle without stylet
- Inadequate pressure
- Poor post-procedure care
💡 Pro Tip:
Always replace the stylet before removing the needle to prevent CSF leak.
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Post-procedure Care
Post-procedure care involves monitoring for complications, ensuring adequate hydration, and documenting the procedure. Patient should be observed for signs of post-LP headache or other complications.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Post-LP headache | 10-30% | Positional headache, nausea, photophobia | Bed rest, hydration, caffeine, blood patch if severe | Small needle, proper technique |
| Infection | Rare | Redness, warmth, pain at site | Antibiotics, surgical consultation if needed | Strict aseptic technique |
| Bleeding | Rare | Back pain, neurological symptoms | Imaging, neurosurgical consultation | Check coagulation status |
| Nerve injury | Rare | Pain, paresthesia, weakness | Neurological evaluation | Proper technique, patient cooperation |
Clinical Pearls
Proper positioning is crucial for successful LP - ensure spine is well-flexed.
L3-L4 is the preferred interspace for pediatric LP.
Use adequate local anesthetic to minimize patient discomfort.
Advance slowly and feel for the "pop" when entering the subarachnoid space.
Collect samples in the correct order: cell count, protein/glucose, culture, special studies.
Always replace the stylet before removing the needle to prevent CSF leak.
Check for contraindications, especially increased ICP, before performing LP.