PROCEDURE 95 A lumbar puncture is performed for access to the subarachnoid space to obtain a cerebrospinal fluid sample, measure cerebrospinal fluid pressure, drain cerebrospinal fluid, infuse medications or contrast agents, or place a cerebrospinal fluid drainage catheter.1–3,7 • Knowledge of the anatomy and physiology of the vertebral column, spinal meninges, and cerebrospinal fluid (CSF) circulation, including the location of the lumbar cistern, is needed. • Technical and clinical competence in performing lumbar punctures (LPs) is necessary. • Knowledge of sterile technique is needed. • The presence of meningeal irritation caused by either infectious meningitis or subarachnoid hemorrhage may promote discomfort when the patient is placed in the flexed, lateral decubitus position for the LP.3–5,17 • Computed tomography (CT) scan or magnetic resonance imaging (MRI) supersedes the routine use of LP for many diagnoses.5,7,18,28 • Indications for LP include the following4,5,18,28: • Contraindications for LP include the following3,18,28,29: • Normal CSF values include the following18,20,23,28: • Recommended CSF tests include the following18,20,23,28 • Sterile gloves, caps, masks with eye shields or goggles, and sterile gowns • Manometer with three-way stopcock • Lidocaine, 1% to 2% (without epinephrine)
Lumbar Puncture (Perform)
PREREQUISITE NURSING KNOWLEDGE
Suspected central nervous system (CNS) infection
Suspected Guillain-Barré syndrome
Intrathecal administration of medications
Imaging procedures that require infusion of contrast agents
CSF drainage in hydrocephalus, pseudotumor cerebri, or CSF fistula
Increased intracranial pressure with mass effect
Superficial skin infection localized to the site of entry
Bleeding diathesis (relative contraindication)
Platelet count less than 50,000/mm3
International normalized ratio (INR) greater than 1.5
Opening pressure, 0 to 15 mm Hg
White blood cell count, less than 5/mm
Glucose, 60% to 70% of serum blood glucose
EQUIPMENT
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95: Lumbar Puncture (Perform)
