Once in position place a pillow under the head of the patient. Ensure that their knees are drawn into their chest and head tucked to chin to help open up the spinous processes. Lateral decubitus/‘foetal’ position – Ensuring that the bed is flat, ask the patient to lie on their left side with their back flat to the edge of the bed and their shoulders square to their hips.Positioning for Lumbar PunctureĬorrect positioning of the patient is paramount in successfully performing a lumbar puncture. The lumbar puncture needle passes through the following tissues in sequence to reach the subarachnoid space, skin, subcutaneous tissue, the supraspinal ligament, the interspinal ligament, the ligamentum flavum, the dura mater and finally the arachnoid mater. If you go on to use atraumatic needles, familiarize yourself with the apparatus prior to use.STRUCTURES THROUGH WHICH THE SPINAL NEEDLE PASSES They require an introducer needle to puncture the skin, through which the atraumatic needle is passed. Given their non-cutting tip design, atraumatic needles do not puncture the skin as freely as a typical Quincke needle. This reduces the amount of CSF loss post-lumbar puncture, and several randomized double-blind studies have been published showing that post-lumbar puncture headaches are reduced ten-fold when using atraumatic needles. The ‘non-cutting’ tip of atraumatic needles is designed to part the dural fibres rather than shear them, and so upon removal of the needle from the dura a smaller hole remains than with a cutting needle. Sprotte or Whitacre) and typical ‘cutting’ needles (Quincke). Lumbar puncture needles are divided into two types: ‘atraumatic’ needles (e.g. Collection bottles, labels and tin foil. When a possible intracranial bleed is the preliminary diagnosis (in which case a negative computerized tomography of the head should precede subsequent lumbar puncture).Focal abnormal neurology on examination.Symptoms or signs of raised intracranial pressure (persistent vomiting, history of recent seizure(s), reduced Glasgow coma scale, papilloedema).When to perform a head CT CT prior to lumbar puncture: prior to lumbar puncture: prior to lumbar puncture: If you are unsure of the anatomy, consult a senior colleague. Spinal cord deformities are a relative contraindication depending upon the spinal anatomy and the experience of the operator (e.g.Suspected spinal cord mass or intracranial lesion.Raised intracranial pressure (see Tip Box).Coagulopathy (recent aspirin, heparin last 12 hours, international normalized ratio above 1.2, activated partial thromboplastin time ratio above 1.2).Suspected central nervous system infection, e.g.POST-PROCEDURE INVESTIGATIONS OF LUMBAR PUNCTURE.PRACTICAL PROCEDURE FOR LUMBAR PUNCTURE.
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