LUMBAR PUNCTURE

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LUMBAR  PUNCTURE
INTRODUCTION
          It is the instrument which is inserted in the L4 and L5 (between these vertebrae) below the level of spinal cord to drain CSF or to give any medication.

DEFINITION
          Here there is the insertion of fine needle in between the lumbar vertebrates to drain and lower the CSF pressure or inject  any drug.

PURPOSE
Ø      It is used to decrease the volume of the CSF present in lumbar spine
Ø      It is used for inserting any medication
Ø      It decreases the brains supportive cushion
Ø      Of subarachanoid haemorrhage
Ø      Used for assessment of CSF analysis
Ø      In Rx of meningitis
INDICATIONS OF LUMBAR PUNCTURE
          Lumbar puncture is indicated in the investigation of infections like
Ø      Meningitis or encephalitis
Ø      Subarachonoid haemorrhage
Ø      Multiple slerosis
Ø      Sarcoidosis
Ø      Cerebral lupus
Ø      Neurological malignancies like
o       Carcinomatous meningitis
o       Lymphoma and leukaemia
o       To measure CSF pressure
CONTRAINDICATIONS OF LUMBAR PUNCTURE
          Lumbar puncture is contraindicated if there is any suggestion of
Ø      Raised intra cranial pressure
Ø      In depressed level of consciousness
Ø      If there is any bleeding as in Thrombocytopenia.Why?

INTRA PROCEDURE CARE
Ø      Position the client on the side (lateral recumbent) with the back close to the edge of bed
Ø      Ask the client to draw knees upto the knees and chin onto the chest
Ø      Stand in front of client and place one hand behind the clients knees and other around the neck
Ø      After a local anaesthetic is given the clinician places a fine needle is placed or inserted above the top of the iliac crest or usually to the lower L3 and L4 or L4 and L5 in between these vertebrae
Ø      The needle level is usually held parallel to the longitudinal fibres of the dura and reduces the leak of CSF
Ø      Local pain may occur as the needle passes the dura mater. Ask the client to mention additional discomfort which may indicate misplacement of the needle.
Ø      When the needle has entered the subarachonoid space the clinician removes the stylus and attaches a stopclock and manometer to measure CSF pressure. The first stabilized CSF pressure is opening pressure
N pressure is 6 to 13 mm Hg. Pressure exceeding more than 15mm hg are abnormal.
Ø      CSF specimen are collected in a series of small sterile test tubes 2-3 ml of CSF is collected
Ø      CSF specimens are collected
Ø      The needle is with drawn, and the clinician places a dry sterile dressing over the puncture site.

POST PROCEDURE CARE
Ø      Record vital signs after the procedure
Ø      Drinking extra fluid can help to restore CSF volume
Ø      The CSF pressure measurement is indicated a high ICP
Ø      Make the patient comfortable
Ø      Give psychological support for patient and attenders
Ø      The headache occurs after the procedure because of CSF continuous to leak through the opening in the duramater by the needle.
Ø      The fluid loss allows abnormal movements of brain
Ø      Advice the client about headache
Ø      Instruct the client not to move from the bed

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