LUMBER PUNCTURE and Nursing Role

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Definition :

A lumber puncture ( spinal tap ) is carried out by inserting a needle into the lumber subarachnoid space ( beneath the middle layer of the membrane surrounding the spinal cord ) .

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– The needle is inserted into the subarachnoid space between the 3rd and 4th lumber interspace .

The needle is inserted below the level of the 3rd lumber vertebra to prevent the spinal from being punctured .

Purposes of lumber puncture :

– This needle is inserted in order to withdraw cerebrospinal fluid for diagnostic and therapeutic purposes .

Diagnostic Lumber Puncture

1. To measure pressure of CSF within ( brain , spinal cord tumor , infection )

2. To determine the presence or absence of blood in the spinal fluid .

3.To detect spinal subarachnoid block .

4. CSF withdrawn before instilling contrast medium for X-rays of the spinal column.

Therapeutic Lumber Puncture

1.To instill some drugs after withdrawal of a similar amount .

2.To administer antibiotics intrathecally in some cases of infection .

Lumber Puncture Contraindications :

– Signs of cerebral herniation .

– Previous lumber surgery .

– Cardiorespiratory compromise .

– The normal range of spinal fluid pressure with the patient in lateral recumbent position is : 70 – 200 mm H2O

– A successful lumber puncture require that the patient be relaxed , since an anxious patient may become tense , causing an increase in the pressure reading .

Nursing Role in lumber puncture :

1- During explanations, the client should be assured that inserting a needle into the spine will not result in paralysis .

2- Ensure that the client has signed the consent form , if needed .

3- Perform a basic neurological examination including pupil size and response & muscle strength & sensation in all four extremities , this provide a baseline for future comparisons .

4- Prior to LP, encourage the client to empty bladder to promote comfort .

5- Administer a sedative drug if ordered to reduce anxiety .

6- Obtain a prepackage LP kit with a local anesthetic .

7- Gather equipments

• Extra gloves

• Gown

• Collection tubes

• Drape

• Manometer ( if needed )

• Povidine

• Styletted spinal needles

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