The patient required a lumbar puncture and this was done in the standard fashion.
Both written and verbal consent were obtained and the patient is well aware of all risks, benefits and alternatives.
A time out was undertaken to assure that this was the correct patient and the correct procedure for this patient.
The patient was placed in the ___ left lateral decubitus position. The L3-L4 interspace was palpated and identified.
The skin around this area was prepped and cleansed in the usual sterile fashion. A drape was used to create a sterile field.
Lidocaine 1% plain was injected into the tissue of the L3-L4 interspace.
A 22-gauge spinal needle was then inserted through the area of analgesia into the spinal canal.
The stylette was removed and a total of roughly 4 mL of clear fluid was collected in a sterile fashion.
This fluid was sent to laboratory for testing. The stylette was replaced into the needle and the needle was slowly withdrawn. A dry sterile dressing was placed.
The patient tolerated the procedure well and there were no complications.
Neonatal LP
- How much CSF to collect?
- 1.5 mls (or 30 drops) should be both safe, sufficient for even smallest patients
- Where to enter the spine?
- “The spinal cord in adults and older children ends around L1-L2, in neonates it extends down to L3. The sub-arachnoid space extends down to S2. L4-L5 is generally the best area to aim for (bearing in mind we are not always in the space we think we are) though L3-L4 is also OK.”
- How deep to place the needle?
- about 1-2cm
Ultrasound guidance
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