A lumbar puncture (LP) is contraindicated in the following scenarios: Patients with bleeding diathesis, e.g. severe coagulopathy (INR >1.4) and thrombocytopenia (platelet <50 x 109/L). If coagulopathy or thrombocytopenia is not corrected prior to the procedure, spinal hematomas resulting in spinal cord compromise may result. Patients with increased intracranial pressure due to an intracranial lesion…
Patient Position A lumbar puncture (LP) can be performed with the patient in the lateral recumbent position or sitting upright. The lateral recumbent position is preferred because it allows accurate measurement of the opening pressure. The patient shown in the photo here is in the left lateral recumbent position. Positioning of the patient is crucial…
In the video shown here, the patient is in the left lateral recumbent position. The lumbosacral region of the patient is clearly exposed. The doctor has put on sterile gloves and is applying disinfectant over the lumbar region. Sterile draping is then applied as shown in the photo here.
By palpating onto the iliac crest and spinal processes of the back, the site of needle puncture for lumbar puncture (LP) is identified. As the spinal cord ends at the level of L2 in adults, the spinal needle can be inserted safely between the L3/4 or L4/5 levels. The highest point of the iliac crest…
Lumbar punctures (LPs) are relatively safe procedures. However, some of the complications include: Post-lumbar puncture headache This is one of the most common complications after LP and occurs in 10-30% of patients receiving a LP. This is due to leakage of cerebrospinal fluid from the dura and traction on pain-sensitive structures. Patients with post-LP headache…