Lumbar Puncture: Comprehensive Clinical Protocol

Pre-Procedure Assessment

Indications

• Diagnostic CSF sampling
• Measurement of opening pressure
• Therapeutic CSF removal
• Administration of intrathecal medications

Contraindications

• Increased intracranial pressure (ICP)
• Local infection at puncture site
• Coagulopathy (INR > 1.5 or platelets < 50,000)
• Suspected spinal epidural abscess

Required Equipment

• Sterile LP tray
• Spinal needles (22-25G)
• Manometer set
• Collection tubes (4)
• Sterile drapes and PPE

Procedure Steps

1. Patient Positioning

• Lateral decubitus position preferred
• Knees-to-chest, spine flexed
• Alternative: Seated position if required

2. Site Preparation

1. Identify L3-L4 or L4-L5 interspace
2. Mark insertion site
3. Perform sterile prep
4. Apply sterile drapes

3. Anesthesia

• Infiltrate 1-2% lidocaine
• Allow 2-3 minutes for effect

4. Needle Insertion

1. Insert needle with bevel parallel to dural fibers
2. Advance slowly through tissue planes
3. Note characteristic "pop" on dural penetration
4. Remove stylet to check CSF flow

5. CSF Collection

1. Measure opening pressure if indicated
2. Collect required samples in sequence:
   • Tube 1: Cell count/differential
   • Tube 2: Chemistry/glucose
   • Tube 3: Protein
   • Tube 4: Culture/special studies

6. Completion

1. Replace stylet
2. Remove needle in single motion
3. Apply pressure dressing

Post-Procedure Care

Monitoring

• Vital signs q15min for first hour
• Assess for headache or complications
• Monitor puncture site

Patient Instructions

• Lie flat 1-2 hours
• Increase fluid intake
• Avoid strenuous activity for 24h
• Report severe headache or neurological symptoms

Documentation Requirements

• Indication for procedure
• Informed consent
• Technique used
• CSF appearance and pressure
• Specimens collected
• Complications if any
• Post-procedure instructions given