LUMBAR PUNCTURE
What is Lumbar puncture?
It is test performed on the back of the patient to obtain CSF for diagnostic purpose or to inject medication for various reasons. It is done in the lower part of the back after a local anesthesia. it is also called as spinal tap.
Why it is performed?
It is performed to take out spinal fluid for diagnostic purpose as well to inject drugs as therapy e.g. spinal anesthesia, intra-thecal chemotherapy etc.
Image Source: https://www.ncbi.nlm.nih.gov/books/NBK65913/figure/CDR0000257997__334/
Image Source: https://www.verywellhealth.com/lumbar-punctures-common-questions-answered-2488675
How it is performed?
It is performed by a skilled doctor after obtaining a consent for the procedure. This can be done in lateral position as well in sitting position but most commonly it is done is lateral position.
For the lateral position Patient is asked to curl-up legs and neck and asked to bring them up to the chest and be in same position till the position is performed.
For the sitting position, patient is made to sit at the edge of the bed with the legs dangling down and bending the head downwards till the procedure is performed.
In the given position, painting and draping is done as an aseptic precaution. Than the level is chosen by the doctor and local anesthesia [ 2% lignocaine] is given into the desired place.
After about one to two minutes, a long and thin needle is inserted into the spinal space till the CSF is coming out of the needle.
Once the needle is in the proper position, CSF fluid is collected into the sterile test tubes [and drug is injected into the spinal space- subarachnoid space].
Once the sample is collected the needle is removed and the puncture is sealed. Patient is asked to sleep in supine position with 15-30° head low, to prevent post puncture headache.
What are the possible complications?
- Post-dural puncture headache
- Backache or discomfort
- Brainstem herniation
- Infection
- Transient nerve palsies
What if not performed?
This is a simple bedside test, which given detail information about the CSF and presence of infection or any other pathology in the brain. It it is not performed the definitive diagnosis remains in question.
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