Lumbar Puncture

WHAT YOU SHOULD KNOW:

• Lumbar puncture, also called LP, is a procedure where a needle is inserted in your back and into the spinal canal. This is 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. You cannot have an LP if you have increased pressure in the brain. This increased pressure may be caused by a tumor or blockage. If you bleed easily or an infection is present in the area where the needle will be inserted, a LP will not be 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 back to treat a disease. CSF pressure may also be measured during LP.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

Having a lumbar puncture may put you at risk of having other problems. You may have a headache that gets worse when you sit or stand. You may also have neck or back pain. There may be bleeding, infection, injury to a disk in your spine, or spinal fluid may leak from the site. Your 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 for problems. LP may not be advised for those who are vomiting, have a bad headache, or have problems staying awake. Talk with your caregiver if you are worried or have questions about your procedure, medicine, or care.

WHILE YOU ARE HERE:

Before your procedure:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• Gown: A hospital gown is used so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. When you feel better you may be able to wear your own gown or pajamas.
  
  
• Local anesthesia: This is medicine to make you more comfortable during your procedure or surgery. It is a shot of medicine put into the skin. It is used to numb the area and dull your pain. You may still feel pressure or pushing during the procedure or surgery after you get this medicine.

During your procedure:

• You will be asked to lie on your side, or to sit up. If you are lying on your side, your knees should be bent and drawn up toward your chest. Your neck should be tucked toward your chest and you may be given a pillow. If you are sitting, you will need to bend forward with your neck tucked toward your chest. You may be given medicine to help you relax or make you drowsy.
  
  
• Your caregiver will feel your lower spine to look for the best place to do the LP. He will mark this position using a marker. Your lower back is cleaned with a special cleanser. You may be given one or more shots of numbing medicine under the skin. A needle is inserted between the vertebrae (spine) in your lower back. You may feel some pushing or discomfort as the needle enters your back. Tell your caregiver if you have pain that does not stop within a few seconds. Your 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 caregiver may take readings of your CSF pressure. This is done by connecting a measuring device to the needle. After the pressure is measured, the device is removed and CSF is allowed to flow out of the needle. Samples of your 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 procedure: You will need to lie flat in bed for a time that may be between 1 and 24 hours. You should lie flat in bed and not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you may be allowed to go home. If caregivers want you to stay in the hospital, you will be taken back to your hospital room. Tell a caregiver if you have a headache, back pain, or tingling, numbness, or weakness below your waist.

• Post-lumbar puncture headache: You may develop a headache during the first few hours after your 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 you sit or stand. You may have neck or back pain as well. The following may help ease or prevent a post-lumbar puncture headache:
  
  
  • Drinking liquids: You may be asked to drink more liquid than usual after your LP. For most people, good liquids to drink include water, milk, and juices. Do not drink alcohol. Tell your caregiver if you cannot drink a lot of liquid because of another medical condition, such as a heart or kidney condition.
    
    
  • Lying down: You may need to lie flat for some time after your LP. Ask your caregiver how long you need to lie down.
    
    
  • Treatment options: You 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 headache pain. Caffeine may be given by mouth in caffeinated drinks, such as coffee or soda, every 4 to 6 hours while you are lying down. You may also be given caffeine intravenously (IV) through a tube placed in your vein. You may be given more than one caffeine IV.
        
        
      • Pain medicine: You may need medicine to relieve or decrease your headache pain. These medicines may include NSAIDS (non-steroidal anti-inflammatory medicine), such as ibuprofen, acetaminophen, or medicine that your caregiver orders (prescription) for you. Your caregiver will decide which medicine is best for you to take for your headache. Follow your caregiver's instructions on how to take your medicine. Tell your caregiver if the pain medicine does not help or if you have any questions about your medicine.
      
      
    • Procedures: You may have any of the following:
      
      
      • Blood patch: If your 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 blood, that is taken from a vein, to patch (seal) the LP leak. The blood is put through a needle into your spinal canal in the same way that the LP was done. You will need to lie in bed for 1 to 2 hours after this procedure. This procedure may need to be repeated if your headache is not relieved.
        
        
      • Saline epidural: A saline epidural may be given if your headache is caused by low CSF pressure due to a leak. This procedure puts saline (an IV fluid) back into your spinal canal to increase CSF pressure. The increased pressure may help to seal the leak. The saline is put through a needle into your spinal canal in the same way that the LP was done.
  
  
• Bedpan: You may not be able to get out of bed to urinate or to have a bowel movement (BM). If you cannot get out of bed you will use a bedpan. Ask your caregivers if you need help using the bedpan.
  
  
• Monitoring:
  
  
  • Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
    
    
  • Neurologic signs: Neurologic signs are also called neuro signs, neuro checks, or neuro status. Caregivers check your eyes, your memory, and how easily you wake up. Your hand grasp and balance may also be tested. This helps tell caregivers how your brain is working after an injury or illness. You may need to have your neuro signs checked often. Your caregiver may even have to wake you up to check your neuro signs.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

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.

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