Lumbar Puncture Part 1: The Basics

a monthly blog series on procedures


Hunting & Gathering

Find a Workstation on Wheels (WOW) with a functioning Topaz to obtain informed consent.

Place Epic orders for CSF. Print the stickers and sign each with your initials.

Locate an LP tray,  its contents, sterile gloves, eye protection, facemask.

Gather these optional supplies:

  • Extra spinal needles:
    • 20 gauge, 3.5 in Quincke = cutting needle (1 included in tray).
    • 22 gauge, 3.5 in Whitacre = atraumatic needle.
    • 20 gauge, 6 in “Harpoon” = longer needle.
  • Extra 1% Lidocaine (5ml in tray).
  • Extra Povidone-Iodine.
  • Non-sterile marking pen.

Optional: Tech or RN for positioning assistance during procedure.

Timeout!

Perform the LP (see below).

Collect CSF in 4 tubes and send to lab.

Choosing the right needle

The Whitacre needle (aka a type of pencil point needle, or “atraumatic” needle) contains side ports, and theoretically causes less damage to tissue fibers upon entry. They are more difficult to use for skin entry. However, studies have shown that atraumatic needles decrease the incidence of post-LP headache (1 and 2). As an aside, there is no evidence that lying supine for any fixed period time is helpful in the prevention of post-LP headache(3). Continue reading