Lumbar Puncture

Lumbar Puncture

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This high quality video demonstrates lumbar puncture on a live patient. One of the most commonly performed emergency and hospital based procedures, lumbar puncture is shown step by step. Clinical pearls and common pitfalls associated with lumbar puncture are discussed in detail.  The video is not downloadable but may be accessed indefinitely by internet from any computer, smart phone, or tablet. Click below to preview the Lumbar Puncture video.

 

The patient is positioned in lateral decubitus position and asked to arch the back as much as possible. Ideally, the hips and the shoulders are square to the bed. The back is then sterilely prepped with betadine and draped in such a fashion that you can still palpate the iliac crest and remain sterile.

This is a picture of the lumbar puncture tray that has been set up with the sterile tubes already upright. We are now drawing back some 1% lidocaine for local anesthesia. The local anesthesia is then used to numb up the skin and underlying soft tissue. We have localized the L2-3 inner space between the two fingers and we are now numbing up the deeper soft tissue.

Of course as you advance the needle you always want to aspirate to assure that you are not in a blood vessel prior to injection of the lidocaine. A spinal needle is now inserted. In adults you can usually feel a pop or a loss of resistance when the dura has been punctured. The stylet is then removed and you should have return of clear spinal fluid.

A manometer can be applied to measure the opening pressure which is determined when the spinal fluid starts oscillating in the manometer. The manometer is now removed and spinal fluid is collected in all of the four sterile vials. The spinal fluid will then be sent off for culture, gram stain, cell count, glucose, protein and any other special studies.

The stylet is replaced and then the entire unit with the stylet and needle are withdrawn from the skin. A Band-Aid is then applied and the patient is asked to lie flat for approximately an hour to minimize the chance of a spinal headache.