Spinal anesthesia and lumbar puncture

Lumbar puncture / spinal tap

A time-out, which The Joint Commission defines as “an immediate pause by the entire surgical team to confirm the correct patient, procedure, and site Indications ⇒ for meningtisi and also for haemorrahge if imaging not clear and in doubt. Use a spinal needle, CSF should be clear and crystal.

Iliac creasts and intersection of the spinal cord. Must go in this L2 and L# region which is below the spinal cord and has big csf space and less peripheral nerves. Go in L4 region. Can palpate or use iliac crests. Aim towards umbilicus , push and if you feel pressure then readjust. again do it until you feel less pressure and then check whether csf comes off. Pure csf not just injury bleeding.

Risks ⇒ bleeding, infection and nerve damage. Post tap headache? Its a sterile procedure so need gowning up and covering. Must do neural exam before and after procedure to check nerve damage. Sometimes ligaments can be calcified. Can do lateral appraoch to avoid these cacifications. Just laterally but aim at the midline of the dura,

How to measure ICP?

Take spinal needle out and then attach the monometer instead. Allow the CSF to come out

Normal pressure is between 6 and 20 cm water. Abnormal is greater than 25.

After measuring the pressure you can let the sample roll back out teh pressure gauge into sample collectors

Need to take 2ml per bottle to be very sure of sucessful analsysis.

But the body produces 500ml per day which is 25ml per hour. So if take 10ml can easily replace this within half an hour.

Put stylet in before taking it out to avoid nerve damage.