Lumbar Puncture In Children

WHAT YOU SHOULD KNOW:

• Lumbar puncture, also called LP, is a procedure where a needle is inserted in your child's back and into his spinal canal. This may be done to collect cerebrospinal fluid (CSF) or treat certain medical conditions. The spinal canal contains the spinal cord, which carries messages between your brain and your body, and CSF. CSF is a clear fluid that flows around the brain and inside the spinal canal. This fluid contains information about body functions and disease processes. It also acts as a cushion to protect the brain and spinal cord from injury. LP may be used to check for an infection, inflammation (swelling), or other conditions affecting the brain. Your child cannot have an LP if he has increased pressure in his brain. The increased pressure may be caused by a tumor or blockage. If your child bleeds easily or an infection is present in the area where the needle will be inserted, a LP is not done.
  
  
• During a lumbar puncture, CSF may be collected and sent to a lab for tests. The tests check for changes in the CSF, including the presence of blood, protein, glucose (sugar), and germs. The sample may also be used to do certain tests that check for an infection. Sometimes, medicine may be put through the LP into your child's back to treat a disease. CSF pressure may also be measured during LP.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

Having a lumbar puncture may put your child at risk of having other problems. He may have a headache that gets worse when he sits or stands. He may have neck or back pain, feel sick to his stomach or vomit (throw up). He may have problems with his eyesight and hearing, such as blurred or double vision, dizziness, and ringing in his ears. There may be bleeding, infection, injury to a disk in his spine, or spinal fluid may leak from the site. Your child's nerves or spinal cord may be damaged. Medicines, including anesthesia, that are used during the procedure may cause an allergy. Patients who have blood disorders or who are taking certain medicines are at a higher risk of problems. LP may not be advised for those who are vomiting or have a bad headache. Talk with your child's caregiver if you are worried or have questions about your child's procedure, medicine, or care.

WHILE YOU ARE HERE:

Before your child's procedure:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.
  
  
• Emotional support: Stay with your child for comfort and support as often as possible while he is in the hospital. Ask another family member or someone close to the family to stay with your child when you cannot be there. Bring items from home that will comfort your child, such as a favorite blanket or toy.
  
  
• Local anesthesia: This is medicine to make your child comfortable during the procedure. It is a shot of medicine put into the skin. It is used to numb the area and dull your child's pain. Your child may still feel pressure or pushing during the procedure.

During your child's procedure:

• If your child is an infant or young child, he may be held by a caregiver during the LP. This is to make sure that he is in the correct position. If your child is older, he will be asked to lie on his side. His knees will be bent and slightly drawn toward his chest. His neck should be slightly tucked toward his chest and he may be given a pillow. He may be given medicine to help him relax or make him drowsy. The caregiver will feel your child's spine to look for the best place to do the LP. He will mark this position using a marker. Your child's lower back is cleaned with a special cleanser. Your child is then given one or more shots of numbing medicine under the skin. A needle is inserted between the vertebrae (spine) in your child's lower back. Your child may feel some pushing or discomfort as the needle enters his back. Sometimes, the caregiver may need to pull out, reinsert, or change the position of the needle to find the spinal canal. Fluoroscopy may be used, or a CT scan may be done during the procedure.
  
  
• Your child's caregiver may take readings of your child's CSF pressure. This will be done by connecting a measuring device to the needle. After the pressure is measured, the device will be removed and CSF will be allowed to flow out of the needle. Samples of your child's CSF may be taken and placed in different sterile (clean) small bottles. The needle is then taken out and the procedure area will be covered with a bandage.

After your child's procedure:

Your child will need to lie flat in bed for a time that may be between 1 and 24 hours. He should lie flat and not get out of bed until his caregiver says it is OK. When caregivers see that your child is OK, your child may be able to go home. If caregivers want your child to stay in the hospital, he will be taken back to his hospital room. Tell a caregiver if your child has a headache, back pain, or tingling, numbness, or weakness below the waist.

• Post-lumbar puncture headache: Your child may develop a headache during the first few hours after his LP, which may last up to several days. This happens when the amount of CSF and the CSF pressure are decreased, such as with a CSF leak. The headache may range from mild to severe (very bad) and may get worse when he sits or stands. He may have neck or back pain, feel sick to his stomach or vomit (throw up). He may have problems with his eyesight and hearing, such as blurred or double vision, dizziness, and ringing in his ears. The following may help ease or prevent a post-lumbar puncture headache:
  
  
  • Drinking liquids: Your child may be asked to drink more liquid than usual after his LP. For most people, good liquids to drink include water, milk, and juices. Tell your child's caregiver if he cannot drink a lot of liquid because of another medical condition, such as a heart or kidney condition.
    
    
  • Lying down: Your child may need to lie flat for some time after his LP. Ask your child's caregiver how long he needs to lie down.
    
    
  • Treatment options: Your child may have any of the following:
    
    
    • Medicines:
      
      
      • Caffeine: Caffeine may be used to treat a LP headache. As CSF pressure decreases, such as with a leak, blood vessels in the brain will dilate (get bigger) to get more fluid to the brain. Headache pain is caused by the blood vessels getting bigger. Caffeine causes the blood vessels in the brain to narrow (get smaller), which will decrease your child's headache pain. Caffeine may be given by mouth in caffeinated drinks, such as soda, every 4 to 6 hours while he is lying down. Your child may also be given caffeine intravenously (IV) through a tube placed in his vein. Your child may be given more than one caffeine IV.
        
        
      • Pain medicine: Your child may need medicine to relieve or decrease his headache pain. These medicines may include NSAIDS (non-steroidal anti-inflammatory medicine), such as ibuprofen, acetaminophen, or medicine that your child's caregiver orders (prescription) for him. Your child's caregiver will decide which medicine is best for your child to take for his headache. Follow the instructions of your child's caregiver on how your child should take his medicine. Tell your child's caregiver if the pain medicine does not help or if you have any questions about your child's medicine.
      
      
    • Procedures: Your child may have any of the following:
      
      
      • Blood patch: If your child's headache is caused by a leakage of CSF from the LP site, a blood patch procedure may be needed. This procedure uses a small amount of your child's blood, that is taken from a vein, to patch (seal) the LP leak. The blood is put through a needle into your child's spinal canal in the same way that the LP was done. Your child will need to lie in bed for 1 to 2 hours after this procedure. This procedure may need to be repeated if your child's headache is not relieved.
        
        
      • Saline epidural: A saline epidural may be given if your child's headache is caused by low CSF pressure due to a leak. This procedure puts saline (an IV fluid) back into your child's spinal canal to increase CSF pressure. The increased pressure may help to seal the leak. The saline is put through a needle into your child's spinal canal in the same way that the LP was done.
  
  
• Antinausea medicine: This medicine may be given to calm your child's stomach and control vomiting (throwing up).
  
  
• Bedpan: Your child may not be able to get out of bed to urinate or to have a bowel movement (BM). If your child is older and cannot get out of bed, he may be given a bedpan. Ask your caregivers if you or your child needs help using the bedpan.
  
  
• Monitoring:
  
  
  • Vital signs: Caregivers will check your child's blood pressure, heart rate, breathing rate, and temperature. They will also ask you or your child about his pain. These vital signs give caregivers information about your child's current health.
    
    
  • Neurologic signs: Neurologic signs are also called neuro signs, neuro checks, or neuro status. Caregivers check your child's eyes, memory, and how easily he wakes up. Your child's hand grasp and balance may also be tested. This helps tell caregivers how your child's brain is working after a procedure. Your child may need to have his neuro signs checked often. Your child's caregiver may even have to wake him up to check his neuro signs.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.