Lumbar Puncture Video

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Description: Full Detailed video on how to do a lumbar puncture.
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A lumbar puncture (also called a spinal tap) is a procedure to collect and look at the fluid (cerebrospinal fluid, or CSF) surrounding the brain and spinal cord.

During a lumbar puncture, a needle is carefully inserted into the spinal canal low in the back (lumbar area). Samples of CSF are collected. The samples are studied for color, blood cell counts, protein, glucose, and other substances. Some of the sample may be put into a special culture cup to see if any infection, such as bacteria or fungi, grows. The pressure of the CSF is also measured during the procedure.

This is done to:

· Find a cause for symptoms possibly caused by an infection (such as meningitis), inflammation, cancer, or bleeding in the area around the brain or spinal cord (such as subarachnoid hemorrhage).
· Diagnose certain diseases of the brain and spinal cord, such as multiple sclerosis or Guillain-Barré syndrome.
· Measure the pressure of cerebrospinal fluid (CSF) in the space surrounding the spinal cord. If the pressure is high, it may be causing certain symptoms.

A lumbar puncture may also be done to:

· Put anesthetics or medicines into the CSF. Medicines may be injected to treat leukemia and other types of cancer of the central nervous system.
· Put a dye in the CSF that makes the spinal cord and fluid clearer on X-ray pictures (myelogram). This may be done to see whether a disc or a cancer is bulging into the spinal canal.

In rare cases, a lumbar puncture may be used to lower the pressure in the brain caused by too much CSF.

Before the lumbar puncture, take note of the ff:

· About any medicines taken by the patient. Some medicines may contraindicate with the procedure.
· Allergic reactions to any medicines, such as those used to numb the skin (anesthetics).
· Note if patient had bleeding problems or had taken blood-thinners, such as aspirin or warfarin (Coumadin).
· Patient might be pregnant.
· Patient had taken any herbal remedies. Some of these remedies may thin the blood.

Ask the patient to empty his/her bladder before the procedure.

A legal consent must be secured.

How It Is Done

A lumbar puncture may be done in the doctor's office, in an emergency room, or at bedside in the hospital. It may also be done in the radiology department if fluoroscopy is used.

Tell the patient to lie on a bed on his/her side with the knees drawn up toward his/her chest. Or he/she may sit on the edge of a chair or bed and lean forward over a table with his/her head and chest bent toward his/her knees. These positions help widen the spaces between the bones of the lower spine so that the needle can be inserted more easily. If fluoroscopy is used, tell patient to lie on his/her stomach so the fluoroscopy machine can take pictures of the spine during the procedure.

The doctor will mark the patient's lower back (lumbar area) with a pen where the puncture will occur. The area is cleaned with a special soap and draped with sterile towels. A numbing medicine (local anesthetic) is put in the skin.

Then a long, thin needle is put in the spinal canal. When the needle is in place, the solid central core of the needle (stylet) is removed. If the needle is in the right spot in the spinal canal, a small amount of cerebrospinal fluid (CSF) will drip from the end of the needle. If not, the stylet will be put back in and the needle will be moved in a little farther or at a different angle to get to the fluid. The doctor may need to move to another area of the spine if it is hard to get to the spinal fluid.

When the needle is in the spinal canal, a device called a manometer is hooked to the needle to measure the pressure of the CSF. The patient may be asked to straighten his/her legs while he/she is lying down. The doctor takes the pressure reading, called the opening pressure, and checks whether the fluid is clear, cloudy, or bloody. Several small samples of fluid are collected and sent to the lab for study.

A final pressure reading, called the closing pressure, may be taken after the fluid samples are done. The needle is taken out and the puncture site is cleaned and bandaged.

The entire procedure takes about 30 minutes.

To lower the chance of getting a headache following a lumbar puncture, the patient may be told to lie flat in bed or with his/her head slightly raised for 1 to 4 hours. Since the brain makes new CSF all the time and replaces it 2 to 3 times a day, the small amount of fluid that is removed will be quickly replaced. The patient may be told to drink extra fluids after the procedure to help prevent or to reduce the severity of a headache.

How It Feels?

Some people find it uncomfortable to lie curled up on their side. The soap may feel cold on their back. They will probably feel a brief pinch or sting when the numbing medicine is given. They may feel a brief pain when the spinal needle is inserted or repositioned.

During the procedure, the needle may touch one of their spinal nerves and cause a tingling feeling, like a light electrical shock, running down one of their legs. The needle will not touch or damage the spinal cord.

Some people (10% to 25%) develop a headache after having a lumbar puncture. Of those who do get headaches, only about half report that they are severe. These headaches last 24 to 48 hours and go away on their own. Pain medicine does not help control the headache, but lying flat in bed for several hours after the procedure may help the headache.

Patient may feel tired and have a mild backache the day after the procedure. Some people have trouble sleeping for 1 to 2 days.

Risks

A lumbar puncture is generally a safe procedure. In some cases, a leak of cerebrospinal fluid (CSF) may develop after a lumbar puncture. Symptoms of this problem are a headache that does not go away after 1 to 2 days. A CSF leak can be treated with a blood "patch," in which the person's own blood is injected into the area where the leak is occurring in order to seal the leak.

About 1 in 1,000 people who have a lumbar puncture have a minor nerve injury. This heals on its own with time. There is also a small chance of infection of the CSF (meningitis), bleeding inside the spinal canal, or damage to the cartilage between the vertebrae.

People who have bleeding problems and those who are taking blood-thinning medicine (such as warfarin or heparin) have a higher chance of bleeding after the procedure. A lumbar puncture may not be done unless it is needed for a life-threatening illness.

A lumbar puncture may cause serious problems for people who have high pressure in the brain caused by a tumor, a pocket of infection in the brain (abscess), or major bleeding inside the brain. The doctor will check the patients nervous system, spinal cord and brain before doing a lumbar puncture. In some cases, a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan may be done before the lumbar puncture to know that it is safe to do the puncture.

Watch out for:

· Chills or a fever.
· A stiff neck. This may be a sign of a developing infection.
· Any drainage or bleeding from the puncture site.
· A severe headache.
· Any numbness or loss of strength below the puncture site.

If you have notice any of the signs, inform the doctor immediately.