Thursday, January 24, 2019

Lumbar Punctures

emDocs - January 24, 2019 - Author: DeVivo A
Edited by: Koyfman A; Long B; and Singh M
"Pearls and Pitfalls
Positioning is vital to the success of any procedure, but particularly in the performance of a lumbar puncture. Both the patient and provider must be appropriately positioned and comfortable before starting.
  • Take as much time as needed to become comfortable with the anatomic landmarks of the patient. If you are unable to consistently find an adequate space for the procedure, try using a marking pen.
  • Having an assistant hold the patient in position during the needle insertion can help maintain ideal procedure conditions and assuring the patient stays adequately flexed in an attempt to widen the intervertebral spaces.
  • If your first attempt is unsuccessful, reassess your plan, and try something different. This may be as simple as a slight repositioning of the patient, or attempting the procedure at a different intervertebral space.
  • If you feel as if you are hitting bone, slightly withdraw the needle and redirect superiorly towards the umbilicus, as you’re likely hitting the vertebral spinous process.
  • If there is any concern for elevated ICP, space occupying intracranial lesion, or abnormalities in the neurologic exam, a CT scan of the brain should be performed first.
  • When a lumbar puncture is being performed due to concern for meningitis, a CT and/or lumbar puncture should not delay antibiotic administration."