Teaching Visual

Chapter 50 Teaching Visual


Lumbar Puncture



Patrice Kruszewski, DO , Glenn R. Stryjewski, MD, MPH



Objectives



image Visualize spinal anatomy to enhance understanding of the lumbar puncture (LP)

image Describe preparation and performance of a lumbar puncture

image Obtain informed consent from patient and/or family for performing a lumbar puncture


Medical Knowledge



Before Starting the Procedure


Contraindications to performing an LP:


• Increased intracranial pressure (ICP): If there is clinical suspicion of increased ICP, LP should not be performed. Fundoscopic examination of the eye, as well as a CT scan of the head, may be required to rule out intracranial mass lesions. A negative CT scan of the head does not rule out increased ICP definitively, but it does help to rule out the risk for herniation.

• Thrombocytopenia: Most clinicians will not perform an LP if the patient’s platelet count is less <50,000.

• Unstable patient: For example, if the patient is unable to be safely positioned for the LP because of compromised respiratory status

If the above conditions have been excluded, it should be safe to proceed with the procedure.



Beginning the Procedure


Obtain an LP procedure kit, and position items where they are easily reached without contaminating your sterile field:


• Spinal needle

• Sterile cerebrospinal fluid (CSF) collection tubes (at least three, and more if needed)

• Sterile gloves: antiseptic solution

• Sterile gauze pads

• Sterile drape

• Band-Aid


Positioning the Patient


There are two ways of positioning patients for an LP (Figure 50-1):


• Lateral recumbent position
• An assistant helps by flexing the patient’s neck and drawing the patient’s knees to the patient’s chest.

• Remember to keep the patient’s shoulders and hips perpendicular to the bed. This keeps the spinal column in alignment.

• Sitting position
• This position may be used for older patients.

image image

Figure 50-1 Positioning the patient. A, Lateral recumbent position. B, Sitting position.


An imaginary line between the iliac crests should intersect the midline just above the L4 vertebra (see Figure 50-1).



Prepping the Area



• Remove any anesthetic cream (e.g., EMLA) if it was applied.

• The clinician wears sterile gloves and cleanses the area with povidone-iodine–soaked sterile sponges at least three times.
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Jul 18, 2016 | Posted by in PEDIATRICS | Comments Off on Teaching Visual

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