What is the procedure for a lumbar puncture?

1. Instruct the patient to lie on the side on the hard board bed, with the back perpendicular to the bed surface, flex the head forward to the chest, hold the knees with both hands close to the abdomen, and make the torso arched; Hold the fossa of both lower extremities and hold them tightly to make the spine kyphosis in order to widen the intervertebral space and facilitate needle insertion.

  2. Determine the puncture point, take the intersection of the line connecting the posterior superior spine of the iliac and the posterior midline as the puncture point, generally take the 3-4 lumbar spinous process space, and sometimes it can also be performed in the upper or lower lumbar intervertebral space.

3. After routine disinfection of the skin, sterile gloves and a hole cover were worn, and 2 percent lidocaine was used for local anesthesia from the skin to the intervertebral ligament.

4. The surgeon fixes the skin of the puncture point with the left hand, and holds the puncture needle with the right hand to slowly pierce in the direction of the vertical north. The depth of the needle is about 4-6cm for adults and 2-4cm for children. When the needle passes through the ligament and dura, you can feel the sudden loss of resistance and a sense of loss. At this time, the needle core can be slowly withdrawn (to prevent the rapid outflow of cerebrospinal fluid and cause brain herniation), and the outflow of cerebrospinal fluid can be seen.

5. Connect the pressure measuring tube to measure the pressure before discharging the liquid. The normal lateral position CSF pressure is 0.69-1.764kPa or 40-50 drops/min. If you know whether the subarachnoid space is blocked, you can do the Queckenstedt test. That is, after measuring the initial pressure, the assistant first compresses the jugular vein on one side for about 10 seconds, then on the other side, and finally on both sides of the jugular vein at the same time; under normal circumstances, after the jugular vein is compressed, the pressure of the cerebrospinal fluid immediately doubles rapidly. 10-20s after the release of the compression, it quickly drops to the original level, which is called a negative obstruction test, indicating that the subarachnoid space is unobstructed. If the pressure of the cerebrospinal fluid cannot be increased after the jugular vein is compressed, the infarction-yin test is positive, indicating complete subarachnoid obstruction; if the pressure rises slowly after pressure is applied, and then slowly decreases after relaxation, it indicates incomplete obstruction. All patients with increased intracranial pressure should not perform this test.

6. Remove the pressure measuring tube and collect 2-5ml of cerebrospinal fluid for testing; if culture is required, use aseptic operation to retain the specimen.

7. After the operation, insert the needle core and pull out the puncture needle together, cover it with sterile gauze, and fix it with tape.

  8. After the operation, the patient should go to the pillow and lie prone (if difficult, lie down) for 4-6 hours, so as to avoid postoperative low intracranial pressure headache.

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