A lumbar puncture may be done for various reasons. The most common reason is
to remove a small amount of CSF for testing
. This can help in the diagnosis of various disorders. The fluid is tested for red and white blood cells, protein, and glucose (sugar).
Why is a lumbar puncture done in the lower back?
A lumbar puncture can help
diagnose serious infections
, such as meningitis; other disorders of the central nervous system, such as Guillain-Barre syndrome and multiple sclerosis; or cancers of the brain or spinal cord.
Why is lumbar puncture done below L2?
Since the spinal cord ends as a solid structure around the level of the second lumbar vertebra (L2) the
insertion of a needle must be below
this point, usually between L3 and L4 (Fig 2). The spinal cord continues below L2 down into the sacrum as many separate strands of nerve pathways, the cordae equina, bathed in CSF.
Why is CSF collected from the lumbar region?
A lumbar puncture, or spinal tap, is a medical test that involves collecting a small sample of cerebrospinal fluid (CSF) for examination. This clear, colorless liquid
helps “cushion” the brain and spinal cord
, or central nervous system.
Why would doctors want to perform a spinal tap or lumbar puncture in between the third and fourth lumbar vertebrae?
The spinal cord ends at the level of the first or second lumbar vertebrae, and the needle is usually inserted at a level between the third and fourth or the fourth and fifth lumbar vertebrae,
keeping the spinal cord completely out of danger
.
What are the indications of lumbar puncture?
Indications – Lumbar puncture (LP) is essential or extremely useful in the diagnosis of
bacterial, fungal, mycobacterial, and viral central nervous system (CNS) infections
and, in certain settings, for help in the diagnosis of subarachnoid hemorrhage (SAH), CNS malignancies, demyelinating diseases, and Guillain-Barré …
What lumbar puncture means?
(LUM-bar PUNK-cher)
A procedure in which a thin needle called a spinal needle is put into the
lower part of the spinal column to collect cerebrospinal fluid or to give drugs. Also called spinal tap.
Why is a lumbar puncture needle inserted in the median plane?
At the level of
the lumbar cistern the nerve roots are suspended in CSF and therefore float away from the pressure of the needle
. … Hence it is necessary to remain in the median plane in order to avoid damage to the nerve roots.
What are the functions of CSF?
CSF assists the brain by
providing protection, nourishment, and waste removal
. CSF provides hydromechanical protection of the neuroaxis through two mechanisms. First, CSF acts as a shock absorber, cushioning the brain against the skull.
What is the level of lumbar puncture?
A diagnostic Lumbar Puncture should be performed at the
L3/4 interspinal space
, marked ‘x’. The approximate distance from the skin to the epidural space is 45-55mm and the dura mater may be up to 7mm beyond that depth.
1. LUMBAR PUNCTURE. 2. DEFINITION A lumbar puncture (also called a spinal tap) is
the removal of spinal fluid
(called the cerebrospinal fluid, or CSF) from the spinal canal; the fluid is withdrawn through a needle and examined in a laboratory.
Is a lumbar puncture the same as an epidural?
When a lumbar puncture may be needed
inject a spinal anaesthetic (epidural) – to numb the lower part of your body before an operation. remove some fluid to reduce pressure in the skull or spine.
Why can you do a lumbar puncture with increased intracranial pressure?
Increased intracranial pressure (pressure in the skull) is a contraindication,
due to risk of brain matter being compressed and pushed toward the spine
. Sometimes, lumbar puncture cannot be performed safely (for example due to a severe bleeding tendency).
What diseases can be found in spinal fluid?
- meningitis.
- encephalitis.
- tuberculosis.
- fungal infections.
- West Nile virus.
- eastern equine encephalitis virus (EEEV)
What happens when a lumbar puncture goes wrong?
When spinal fluid is removed during an LP, the risks include
headache from a persistent spinal fluid leak, brain herniation, bleeding, and infection
. Each of these complications are uncommon with the exception of headache, which can appear from hours to up to a day after a lumbar puncture.
Can lumbar puncture damage nerves?
Nerve damage after a lumbar
puncture is extremely rare
(1 in a 1000). Some times during the procedure the nerves that float in the fluid can touch the sides of the needle causing them to be stimulated, when this happens it gives a feeling of tingling down the leg that lasts for a few seconds.
How is a lumbar puncture set up?
- Position the patient either in lateral decubitus / fetal position, or sitting upright leaning forward over a small table.
- Locate the L3/L4 space by locating the superior iliac crests and placing your thumbs midline to the spine. …
- Aseptically clean the skin using chlorhexidine skin prep.
Where is CSF in spinal cord?
CSF is present
within the subarachnoid space
, which covers the brain, spinal cord, and stretches below the end of the spinal cord to the sacrum. There is a connection from the subarachnoid space to the bony labyrinth of the inner ear making the cerebrospinal fluid continuous with the perilymph in 93% of people.
Where is a lumbar puncture needle inserted?
A lumbar puncture (LP) or spinal tap may be done to diagnose or treat a condition. For this procedure, your healthcare provider inserts a hollow needle into
the space surrounding the spinal column (subarachnoid space) in the lower back
to withdraw some cerebrospinal fluid (CSF) or inject medicine.
What is the difference between sagittal and median plane?
Sagittal Plane (Lateral Plane) – A vertical plane running from front to back; divides the body or any of its parts into right and left sides. … Median plane – Sagittal plane through the midline of the body; divides the body or any of its
parts into right and left halves
.
How does CSF get into the spinal cord?
The majority of CSF exits from the fourth ventricle into the subarachnoid space; a small amount may enter the central canal of the spinal cord. In people, CSF enters the subarachnoid space through
the lateral apertures
(foramina of Luschka) and the median aperture (foramen of Magendie) of the fourth ventricle.
How does CSF flow through the brain?
CSF flows from
the lateral ventricles to the third ventricle via the foramen of Monro
. From here, it flows across the cerebral aqueduct of Sylvius to the fourth ventricle and onto the subarachnoid space through the apertures of Magendie and Luschka [3].
Who does lumbar puncture procedure?
A
doctor, nurse practitioner (NP), nurse anesthesiologist, or physician assistant (PA)
performs a lumbar puncture.
Does a lumbar puncture relieve intracranial pressure?
regular lumbar punctures to remove excess fluid from your spine and help
reduce the pressure
on your brain.
Can a lumbar puncture relieve pressure?
A lumbar puncture can be used to:
deliver anesthetic numbing agents to the spinal cord. treat/
relieve hydrocephalus
.
control
CSF pressure and relax the brain during surgery.
What is the risk of doing a lumbar puncture on a patient with intracranial hypertension?
Idiopathic intracranial hypertension patients with mild (numeric rating scale 1–3) or no headache (on the day of lumbar puncture, prior to lumbar puncture) had a high risk of
post- lumbar puncture headache exacerbation
(81% and 67% respectively).
What are two nursing interventions after lumbar puncture?
- Apply brief pressure to the puncture site. …
- Place the patient flat on bed. …
- Monitor vital signs, neurologic status, and intake and output. …
- Monitor the puncture site for signs of CSF leakage and drainage of blood.
Why is lumbar puncture so painful?
There are lots of nerves within the fluid in the spinal canal but usually they have room to move out of the way.
If one of the nerves is touched, it can give you
a nasty ache or pain, usually in your leg. Once the needle is in the right place, it takes a few seconds to get the sample.
Do they sedate you for a lumbar puncture?
A nurse or technologist will insert an
intravenous (IV) line into
a vein in your hand or arm to administer a sedative. This procedure may use moderate sedation. It does not require a breathing tube. However, some patients may require general anesthesia.
How big is a lumbar puncture needle?
Lumbar puncture is also performed therapeutically in some instances. Standard LP needles come in
1.5, 2.5, 3.5 and 5.0 inch lengths
(3.8, 6.4, 8.9, and 12.7 cm, respectively). Selection of LP needle length is typically based on experience; however, an unusually obese or cachectic patient may pose more of a challenge.
What should I do to prepare for a lumbar puncture?
- Maintain your regular eating schedule. …
- Ask your doctor for specific guidelines about discontinuing alcohol use, aspirin products, and blood-thinning drugs before the procedure.
- Tell your doctor if you are allergic to latex or any medications.
How long are you on bed rest after a lumbar puncture?
The duty physician advises you that the patient will require
four hours
bed rest after the lumbar puncture. The duty anaesthetist overhears and says that the patient will be able to go home immediately.
What are the symptoms of leaking spinal fluid?
- Neck or shoulder pain.
- Ringing in the ears (tinnitus)
- Changes in hearing.
- Dizziness.
- Nausea or vomiting.
- Changes in vision.
- Changes in cognition or behavior.
How do I know if my fluid is CSF?
Diagnosing a CSF leak includes
an analysis of the nasal fluid for a protein
called beta-2 transferrin which is most only found in cerebrospinal fluid. CT and MRI scans may also be require to determine the location and severity of the leakage.
Can a lumbar puncture detect Parkinson’s disease?
A lumbar puncture allows
for early determination of the risk of Parkinson disease
and Lewy body dementia. This methodology makes it possible to determine the risk of developing these diseases before symptoms appear in people with REM sleep behavior disorder.
