UNIVERSITY OF BELIZE

FACULTY OF NURSING, ALLIED HEALTH AND SOCIAL WORK

DEPARTMENT OF NURSING
NURS 3501L NURSING CARE OF INFANTS AND CHILDREN
ASSISTING WITH LUMBAR PUNCTURE

Definition
The insertion of a spinal needle into the subarachnoid space between the 3rd and 4th lumbar
vertebrae.

Objectives:
1. To obtain sample's of cerebrospinal fluid for diagnostic purposes.
2. To test the pressure of the cerebrospinal fluid.
3. To relieve pressure on the brain
4. To inject a spinal anesthesia or dye into the spinal canal

Assessment:
1. Assess vital signs prior to, during and following the procedure
2. Assess neurological status prior to and following procedure
3. Assess patients ability to maintain position necessary for procedure
4. Evaluate signs and symptoms that indicate a potential problem could exist if test is
performed.

Equipment
Sterile lumbar puncture set with:
Sterile swabs and gauze
Sterile drapes (One fenestrated)
2 sponge forceps
2 small sterile dressings
3 sterile plain tubes/specimen containers
Sterile gloves
2 - 2ccs hypodermic syringes
Spinal needle - 5 -12.5 cm long with a stylet to insert into the spinal canal
Hypodermic needles 22 and 25 gauge
1 three way stopcock
1 manometer to measure the pressure of the cerebrospinal fluid
Local anesthesia
Antiseptic solution
Mackintosh
Completed laboratory requisition and specimen labels
Adhesive tape
Examination light

Interventions:
Procedure
1. Check physicians order and patient care
plan
2. Wash hands
3. Gather equipment
4. Identify patient
5. Explain procedure to patient. Caution
patient not to cough and to breathe slowly
and deeply during the procedure.
6. Obtain patients written consent
7. Provide privacy
8. Encourage client to empty bladder and
bowels prior to procedure
9. Assist the patient to assume a side-lying
position near the edge of the bed with
knees flexed onto the abdomen and with
the chin flexed unto the chest.
10. Wash hands
11. Don gloves
12. Physicians responsibility:
The area is cleaned with an antiseptic
solution
Drape patient to expose only the
lumbar spine
Local anesthesia is administered
The spinal needle is then inserted
between L3 and L4 into the
subarachnoid space and cerebrospinal
fluid is obtained with the use of a three
way stopcock.
A manometer may be attached to obtain
an initial and closing pressure reading.
A total of 5 10 mls. of cerebrospinal
fluid is collected in three separate
sterile containers.
13. After removal of needle, direct pressure is
applied to the puncture site approximately
3 5 minutes. Place small sterile dressing
2
Rationale
Ensures that patient receives prescribed care
Infection control
Organizes procedure
Ensures that correct patient receives prescribed
care
Allays fear and promotes cooperation
Provides legal protection for the patient, nurse
and the institution.
Maintains patients right to privacy
Prevents unnecessary discomfort and facilitates
procedure.
This position allows for maximum separation
of the 3rd and 4th lumbar vertebrae
Infection control
Infection control
Prevents the introduction of
microorganisms into the spinal canal.
Provides a working field
Decreases patients discomfort
This insertion site reduces the risk of
trauma to the spinal nerves
To detect abnormal pressure readings.
Prevents seepage of cerebrospinal fluid from
the puncture site.
 3

over puncture site.

14. Label the specimen tubes in sequence the
sample was obtained. That is, #1, #2, #3
etc., if they are not already labeled.
15. Instruct patient to lie flat for 8 to 24 hours.
Head to remain flat and even with position
of body
16. Assess the patients response to the
procedure, e.g. pallor, feeling of faintness,
changes in pulse rate and other vital signs,
changes in neurological status, headache,
swelling or bleeding at puncture site,
numbness, tingling or pain radiating down
the legs.
Clinical Alert: Observe for spinal fluid leak
from puncture site.
17. Ensure that the cerebrospinal fluid
specimens and requisition forms are
correctly labeled.
Send specimen to the laboratory
immediately.
18. Make patient comfortable
19. Clean and restore equipment
20. Remove gloves and was hands
21. Document procedure:
Date and time procedure performed
Name of physician
The color, characteristic (clear, cloudy,
blood-tinged, etc) o9f the cerebrospinal
fluid obtained
The pressure readings
The number of specimens obtained
Patients response to procedure.
Specimens are labeled in sequence for protein,
sugar, cell count and bacteria.
Some patients experience post-spinal headache
following a lumbar puncture, and a supine
position tends to prevent or alleviate it.
These symptoms may be present due to nerve
irritation.
Inaccurate identity and/or information on the
specimen container can lead to errors of
diagnosis and/or treatment.
Prevents growth of contaminating organisms
and false results.
Promotes patients comfort
Prevents the transmission of microorganisms
Infection control
Communicates care administered to others and
ensures continuity of care
Cloudy CSF may indicate infection
Blood -tinged CSF may indicate
subarachnoid hemorrhage (or traumatic
LP).

References:

Erb, G. L., Kozier, B. (2004). Kozier & Erb's techniques in clinical nursing: Basic to
intermediate skills. 5th ed. Upper Saddle River, N.J.: Pearson/Prentice Hall.
 4

B.H. 2002; MEP 2015.