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Lumbar Puncture (Adult & Pediatric) (11.17-AP)

Lumbar Puncture (Adult & Pediatric) (11.17-AP) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Diagnostic Tests and Procedures

11.17-AP

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
August 30, 2016

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 11.17AP

Original
Revision

Page
1
of 4

Title: Lumbar Puncture (Adult & Pediatric)

I. PURPOSE

To outline nursing care for the patient undergoing a lumbar puncture. A lumbar
puncture is a procedure where a sterile hollow needle is introduced with a stylet into
the subarachnoid space of the spinal canal for the purpose of diagnosis or treatment.
Indications for lumbar puncture include:
A. Measure Cerebral Spinal Fluid (CSF) pressure
B. Obtain CSF for laboratory tests of visualization
C. Perform spinal dynamics
D. To inject air, oxygen or radiopaque substances for x-ray visualization
E. To remove blood or pus from the subarachnoid space
F. To administer medications
G. To reduce CSF pressure

II. POLICY

The provider is responsible for performing the lumbar puncture. The nurse (RN) will
assist in the procedure as directed by the provider. Any administration of medications
or contrast agents will be performed by the provider and not a RN.

III. EQUIPMENT

A. Sterile disposable adult or pediatric lumbar puncture tray, from Central Services
(CS) (contains listing of equipment on package) (CS Item Number 1212294 for
pediatrics and 1212300 for adults)
B. Extra spinal needles, as ordered (size specified by provider)
C. Prep set (for clipping the area, if indicated)
D. Chlorhexidine swabs for skin prep (preferred) or Duraprep
TM

E. Alcohol sponges
F. Local anesthetic as ordered
G. Masks
H. Sterile gloves
I. Numbered specimen tubes (from sterile disposable lumbar puncture tray), sterile
screw cap container(s) or red top tubes as indicated by physician order. Refer to
Lab Test Directory.
J. Patient labels
K. Sterile 2x2 gauze sponges
L. Adhesive bandage


Page 2 of 4

IV. PROCEDURE

A. Prior to performing, the provider should explain the procedure to the patient
and/or family, assess understanding, and obtain consent.
1. Hospital policies regarding the Universal Protocol should be followed and
documented in the clinical record.
B. Nursing Care
1. Complete and document baseline neurologic assessment.
2. If sedation is ordered and administered, monitor and document according
to adult or pediatric moderate sedation guidelines. (Refer to Hospital
Administrative Policies 8.38, UWHC Adult Sedation Policy or 8.56,
Pediatric Sedation Policy.)
3. Assist with positioning the patient throughout the duration of the
procedure.
a. Adult
i. Usual position is lateral recumbent with a pillow under the
patient's head, buttocks at the edge of the bed, knees flexed
up toward chin, and chin flexed onto chest.
ii. A sitting position may be appropriate for certain patients,
e.g., sitting on edge of bed and leaning onto over-bed table,
or straddling a chair while facing the back of the chair.
b. Pediatric
i. Small children should lie on their side in a fetal position.
No pillow is used under the head. Knees should be brought
close to the chin, and the neck flexed in a downward
position.
ii. Older children may be more comfortable in a sitting
position lying forward with their face down on a table.
c. Neonatal
i. Position infant with hip flexed and back arched in the
lateral decubitus position (knees to chest), or a sitting
position with spine flexed. All intubated patients must be
positioned in the lateral decubitus position, avoiding
flexion of neck.
4. Specimen collection:
a. Label specimens at the bedside comparing labels and requisition
slip to the patient ID band using two patient identifiers.
b. Label specimens and immediately transport to the lab. It is
recommended that specimens be hand-carried, NOT sent in
pneumatic tube system, to prevent accidental leakage or loss.
c. The provider designates the test(s) needed for each numbered
specimen tube. The first specimen may contain red cells from the
puncture wound and should not be used for cell count.
d. The Clinical and Laboratory Standards Institute recommends the
following order for testing for each tube:
i. Tube 1: Chemistry (protein and glucose), special testing,
cells counts only if traumatic tap is suspected
ii. Tube 2: Microbiology (gram stain and culture)
iii. Tube 3: Cell count and differential

Page 3 of 4

iv. Tube 4: Cytology, any additional testing
5. Put dressing or adhesive bandage over puncture site according to provider
request.
6. Post procedure
a. Patient position
i. Assist patient to position ordered by provider. A flat
position is usually desired for one to four (1-4) hours.
Unless contraindicated, patient may turn side-to-side.
Verify patient’s and families’ understanding of the position
and any limitations of activity ordered.
b. Post-procedure assessment: Observe patient closely for any post-
procedure complications. (Patients at increased risk are those with
elevated intracranial pressure.)
i. Mild headache and lower back discomfort may occur.
Encourage oral fluid intake to replace CSF, unless
contraindicated.
ii. Report the following signs/symptoms to the provider:
• Change in level of consciousness
• Lower extremity motor or sensory changes (may
indicate a hematoma at the puncture site)
• Change in vital signs such as apnea, bradycardia,
respiratory depression, increased systolic blood
pressure or increased temperature
• Persistent bleeding or drainage of clear, serous fluid
at the puncture site
7. Documentation
a. Document pre-, intra-, and post-procedure neurologic status and
any nursing interventions performed.

V. UWHC CROSS REFERENCES

A. Health Facts For You 4229, Fluoroscopic Guided Lumbar Puncture/Spinal Tap
B. Health Facts For You 6345, Lumbar Puncture
C. Hospital Administrative policy 4.17, Informed Consent
D. Hospital Administrative Policy 8.38, UWHC Adult Sedation Policy
E. Hospital Administrative Policy 8.48, Operative, Invasive, and Other Procedures
F. Hospital Administrative Policy 8.56, Pediatric Sedation Policy
G. Clinical Laboratories Policy 1502.5.06, Acceptance Policy for Specimen
Identification
H. Nursing Practice Guideline: Sedation (found on U-Connect)

VI. REFERENCES

A. Bowden, V. R., & Greenberg, C. S. (2012). Pediatric Nursing Procedures (3rd
Ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
B. Lynn-McHale, D. J., & Carlson, K. K. (Eds.) (2011). AACN Procedure Manual
for Critical Care (6th Ed.). Philadelphia, PA: WB Saunders Company.
C. Verger, J. T., & Lebet, R. M. (Eds.) (2008). AACN Procedure Manual for
Pediatric Acute and Critical Care (pp 607-612, 623-631). St. Louis, MO:

Page 4 of 4

Saunders Elsevier.

VII. REVIEWED BY

Assistant Director, Clinical Labs
Clinical Nurse Specialist, Neonatal ICU
Clinical Nurse Specialist, Neurosciences
Clinical Nurse Specialist, Universal Care Unit
Clinical Nurse Specialist, Pediatric Hem/Onc.
Clinical Nurse Specialist, Trauma/Critical Care
Nurse Manager, AFCH Diagnostic and Therapy Center
Nursing Patient Care Policy and Procedure Committee, August 2016

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services, Chief Nursing Officer