#Lumbar puncture position skin

See “ Cerebrospinal fluid analysis in meningitis.”.Pleocytosis, lymphocytosis, or granulocytosis.Pseudotumor cerebri ( idiopathic intracranial hypertension) Opening pressures (see also elevated intracranial pressure and brain herniation) To keep the spinal cord alive, insert the needle between 元(-three) and L5(-five). Transport/storage: immediate transport of the samples to the laboratory should be arranged optimum temperature for storage and transport is 20–35☌.Document the lumbar puncture in the patient's file.Recommend bedrest for 1–2 hours and sufficient fluid intake., withdraw the needle, apply a sterile swab, and compress the puncture site. After completion of puncture: Insert the stylet back into the puncture needle.In diagnostic or therapeutic lumbar puncture: Serially collect CSF without active aspiration ( up to 40 mL may be collected).If administering pharmaceuticals: Inject the drug (e.g., local anesthetic such as bupivacaine → spinal anesthesia).If CSF pressure measurement is requested: Place a manometer over the needle hub to measure an opening pressure.Remove stylet after puncture and observe for flow of CSF, which indicates successful entry into the subarachnoid space.Needle passes through the following structures: skin, fascia, fat, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space (in case lumbar puncture is performed for epidural anesthesia, needle should be stopped here), dura mater, arachnoid mater, and subarachnoid space.Initial resistance followed by a noticeable loss of resistance indicates piercing of the ligamenta flava / dura and entry into the dural sac.Angle spinal needle slightly towards the umbilicus and advance slowly (the bevel should point towards the patient's side).Apply local anesthesia to the desired entry point.Wear sterile gloves and place a sterile drape over the patient with an opening over the desired entry point.

#Lumbar puncture position skin

Disinfect the skin over the desired entry point with alcohol and chlorhexidine or povidone-iodine.Alternatively, the patient may be positioned sitting upright or lying prone.The lower lumbar spine should be in flexion.Position the patient in the lateral recumbent fetal position.The spinal needle may be inserted either above ( 元-L4 interspace) or below ( L4-L5 interspace).Identify L4, which is typically located at the level of the iliac crest.Determine the level of entry while patient is upright.

20- or 22-gauge spinal needles are typically used.

Pencil point or “atraumatic” needles are associated with lower rates of post-lumbar puncture headache, although conventional “cutting” needles may also be used.

Explain the procedure to the patient (i.e., the application, purpose, possible complications).