Lumbar puncture positioning: An LP may be done with the patient sitting up straight, lying sideways, or in a prone position. Because they enable more precise measurement of the opening pressure, the lateral recumbent or prone postures are preferable over the upright position.
1Cerebrospinal fluid (CSF) examination following lumbar puncture (LP) is a crucial diagnostic tool for a number of infectious and noninfectious neurologic conditions.
Here, the methods uses, warnings, and issues related to LP in adults will be discussed. Separate discussions are made regarding the technique of LP in children and for spinal and other types of neuraxial anaesthesia.
(For more information, see "Lumbar puncture: Indications, contraindications, technique, and complications in children," "Spinal anaesthesia: Technique," "Epidural and combined 2spinal-epidural anaesthesia: Techniques," and "Spinal anaesthesia: Complications").
In addition to aiding in the diagnosis of CNS infections caused by bacteria, fungi, mycobacteria, viruses, and other pathogens, LP is also often used to assist in identifying subarachnoid haemorrhage (SAH), CNS cancers, demyelinating disorders, and Guillain-Barré syndrome.
With the development of improved neuroimaging techniques like computed tomography (CT) scans and magnetic resonance imaging (MRI), the number of definitive reasons for LP has declined. However, urgent LP is still necessary to detect two critical disorders.
The procedure of a lumbar puncture is common in emergency rooms. The three conditions that it is most frequently used to diagnose are CNS infections, subarachnoid haemorrhage, and inflammatory processes.
Additionally, it can be helpful for people with idiopathic intracranial hypertension.
Providers must be knowledgeable about various techniques for the procedure and be aware of potential complications before performing a lumbar puncture. Like any procedure, a successful outcome depends on careful planning.
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How to position for Lumbar puncture
A patient might be in one of two postures for a lumbar puncture. The preferred position is for patients to lie on their left side (left lateral) with their knees bent and pulled in toward their chest, and their upper thorax curved forward in an almost foetal position.
The midline of the spine, which should ideally be at the same level as the patient's head to provide the most accurate reading, must be at the same level as the point where the needle enters the spine.
A pillow may occasionally be positioned under the patient's head and/or between their legs for comfort. The patient's back should be parallel to the table at all times.
The upright or sitting position is the second position. When the lateral position has failed, use this.
As the patient is asked to roll their shoulders and upper back forward and the chair is positioned to bring the thighs up toward the abdomen, the patient is seated on the edge of the bed with their legs resting on a stool or chair. Where indicated, the opening pressure is measured in the lateral position.
The patient should be carefully moved into the lateral position once the needle is in the proper space if the sitting position is adopted for any reason and an opening pressure is sought.
The style may be removed once the patient is in this position. It's crucial to wait until the patient is safely positioned on the lateral side before removing the stylet.
Some Technique
Once the proper entry point has been found, wash the skin with antiseptic and apply a local anaesthetic, first subcutaneously and then deeper into the layers, ensuring that the anaesthetic is distributed widely.
The spinal needle (see Figure 3) may be inserted into the area after the anaesthetic has had enough time to take effect. Slowly move the needle in the direction of the umbilicus.
Making sure that the cutting needle's bevel is parallel to the direction of the spinal cord and fibres is crucial when using one. Therefore, if the bevel faces to the side when seated, it must face upwards when lying down.
This lessens the possibility of complications following surgery, like headaches. This issue is less likely to occur thanks to the "pencil tip" needle.
The dural space is about 4-5 cm from the skin's surface (see Figure 4) [5,6]. Some practitioners may experience a "give" or "pop" as the needle enters the space when it is advanced, but this is not always the case.
Similar sensations may occasionally be felt as the needle passes through the various layers, but the hand may not yet be in the proper location. As a result, until the space is entered and CSF is drawn, some practitioners periodically advance the arrow and remove the style.
Replace the stylet and advance the needle a few more centimetres this time, or change the needle's angle, if no fluid is obtained. There are longer needles available for some patients.
What position should the nurse position the client after the lumbar puncture?
A lumbar puncture, commonly referred to as a spinal tap, is an invasive technique whereby cerebrospinal fluid (CSF) samples are obtained for qualitative examination by inserting a hollow needle into the region around the subarachnoid space in the lower back. The majority of central nervous system illnesses are identified in connection to alterations in the CSF's dynamics and composition.
Additionally, a lumbar puncture may be performed to take CSF measurements, administer drugs, or insert contrast material into the spinal canal. The operation may be completed as an outpatient in a hospital or clinic and typically lasts between 30 and 45 minutes.
Providing information and instructions before, during, and after a lumbar puncture is one of the duties of the nurse. It will diminish the likelihood of possible problems after lumbar puncture and reduce worry and anxiety among the patient and their relatives.
Conclusion:
The interspinous region between L4 and L5 or L3 and L4 are the best places for the spinal needle to be inserted. By using these markers, you may prevent unintentional harm to the conus medullaris, which usually ends at L1.
Additional resources and citations
- 1Cerebrospinal fluid
- 2spinal-epidural anaesthesia