What position should the nurse position the client after the lumbar puncture?
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Local anesthesia is employed for lumbar puncture (see Technique and Local Anesthetic Agents, Infiltrative Administration). The patient is placed in the lateral recumbent position (see the image below) with the hips, knees, and chin flexed toward the chest so as to open the interlaminar spaces. A pillow may be used to support the head. In a single-center prospective study, performance of lumbar puncture in the extended rather than the flexed lateral recumbent position yielded a statistically significant decrease in the cerebrospinal fluid (CSF) opening pressure, but the difference (mean, 0.6 ± 2.2 cm water) was small and of doubtful clinical significance.  View Media Gallery The sitting position (see the image below) may be a helpful alternative, especially in obese patients, because it makes it easier to confirm the midline. In order to open the interlaminar spaces, the patient should lean forward and be supported by a Mayo stand with a pillow on it, by the back of a stool, or by another person. View Media Gallery If the procedure is performed with the patient in the sitting position and an opening pressure is required (as in the case of pseudotumor cerebri), replace the stylet and have an assistant help the patient into the left lateral recumbent position. There are no data suggesting that a position change will increase the risk of spinal headache or transection of the spinal nerves. Take care, however, not to change the orientation of the spinal needle during this maneuver. Previous Technique
References
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of 11 Tables Back to List Contributor Information and Disclosures Author Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC Coauthor(s) Nirav R Shah, MD, MPH Senior Scholar, Stanford University School of Medicine Chief Editor Helmi L Lutsep, MD Professor and Vice Chair, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, OHSU Stroke Center Acknowledgements Andrew K Chang, MD Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Acknowledgments The authors and editors of Medscape Reference gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article. |
