a monthly blog series on procedures
Take your LP skills to Eleven: this is spinal tap!
Last week we discussed the basics of the adult LP. This week we will guide you through some difficult scenarios and their solutions.
THE SPOOKED PATIENT
- Consider having an assistant hold and position the patient.
- Steady the shaft of the needle with your non-dominant hand.
- Talk to the patient. Here are some examples of what you can say prior to the procedure:
- “I will numb up your back, and that should be the only part that hurts.”
- “Most of the procedure is just setting up my materials.”
- During the procedure, the patient cannot see you, which can be anxiety provoking. Describe each step of the procedure in a calm manner. And try to avoid THIS.
- If necessary, administer an anxiolytic such as a benzodiazepine.
- First, lidocaine!
- Did you inject enough volume into the deeper structures of the back? As Dr. Whit Fisher mentioned in the comments of the previous post, make sure you gather extra lidocaine (only 5ml in the LP tray). In a sterile fashion, draw up an extra 5-10 ml with the help of an assistant.
- Note: if trying a new interspace, make sure this area is also anesthetized.
- Patient still in pain? Consider administration of an analgesic such as an opioid.