LUMBAR PUNCTURE

LUMBAR PUNCTURE Indications Diagnostic purposes analysis of cerebrospinal fluid CSF).  Measurement af CSF pressure or its changes with various maneuvers(Val-  Salva,  etc)  Inject on of various agants:  contrast media for mye ography,  antitumor drugs,  analgesics,  antibiotics Contraindications Increased intracranial pressure(papilledema mass tesion Infection near the site Planned myelography or pneumoencephalography coagulation disorders Materials o A sterile,  disposable lumbar puncture ILP)  kit(rucommended)  or Minor procedure tray 0 spinal nee es(21-gauge fcr acults.  22-gauge for chldren.

 Anatomical Considerations The cbective of a lumbar puncture ILP is tc cbtain a sample of cerchrospinal fluid(CSF)  from the subarachnold space.  Specifically,  during a lumber pureture 1he fluid i3 obtained from the lumbar citem the wolumr CSF dura msler at the coccygel ligament.  The cistern is 3urroundad by the subarach-  noid membrane and the cenying dura Located within the istnm am 1hr filim terminale anc the nerve roots of the cauda cquina When an LP dane,  the main body the spinal co 3 avaded and the nerve ruuts the cauda are simply pushed out the way by the needle.  The termina-  usually between L1 and L2,  and in on of the Bonal cord in an adul patient between L2 and L3.  Ine Batest site tor a lumta purcture is the ne--  space betwcon L4 and LS An imaginary line drawn between the diac cresls the supra cristal plane ntarserts the spine at either the L4 spinous arccess:r tre:  L4-  L5 interspace exactly.  A spinal needle introduced between the sp nous processes cf and L5 pen-  etrales the layers the following order.  skin,  supraspincus igament,  inters-  in ural space contains loose areolar ssue.  and biood vessels J.  dura.  Parania!  space Sukarechnald mem-  rat,