LP (LUMBAR PUNCTURE)

 

  1. Indicated for dx of meningitis, SAH, GB, Lyme, pseudotumor cerebri, neurosyphilis, CA (if mass is small and no shift is present, but it is better to avoid LP all together),  lymphoma.
     
  2. Make sure intracranial mass is ruled-out by CT prior to LP to avoid herniation. This is a subject of controversy. Some determine by clinical exam if there is neurological evidence of intracranial lesion, but in many  institutions CT before LP has become a "standard of care".
     
  3. Prep and anesthetize the area between L4-L5. When pt is in decubiti position this area is identified by placing index finger on iliac crest and thumb on spine to locate a space between the spinal processes.
     
  4. Introduce needle and guide in cephalad direction.
     
  5. When placed properly  2-5 ml of CSF is collected into tubes.
     
    1. Tube #1-glucose, protein.
    2. Tube #2- cell count.
    3. Tube #3- Gram stain.
    4. Tube #4- Ag, titers, VDRL, AFB, India Ink, RBC, xantocromia.
       
  6. When procedure is over, reinsert the stylet, remove the needle and place pt in  supine position   x 1-2 hr.
     
  7. Post-LP headache occurs within 48 hr. Improves with supine position. It is due to oozing of  CSF from dura. It is treated with bed rest and pain medication but if persists, blood patch may  be indicated.
     
  8. To avoid post LP pain patient should be asked to remain supine x 1-2 hr. after procedure.

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