Lumbar puncture - Revision history

Rossdonaldson1 at 23:01, 7 June 2023

2023-06-07T23:01:12Z

← Older revision		Revision as of 23:01, 7 June 2023
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	==Indications==		==Indications==
			[[File:PMC3425284 IJA-56-250-g001.png\|thumb\|Lateral patient positioning for LP.]]
			[[File:Lumbar puncture lines.png\|thumb\|Surface markings for lumbar puncture. Blue dots = Iliac crests; line connecting them = intercristal (Tuffier's) line; intersection of the Tuffier's line and lumbar spine midline = L4 spinous process.]]
	[[File:Sagittal section LP.jpg\|thumb\|Proper needle trajectory: skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space (containing internal vertebral venous plexus), dura, arachnoid, and subarachnoid space]]		[[File:Sagittal section LP.jpg\|thumb\|Proper needle trajectory: skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space (containing internal vertebral venous plexus), dura, arachnoid, and subarachnoid space]]
	[[File:Lumbar puncture lines.png\|thumb\|Surface markings for lumbar puncture. Blue dots = Iliac crests; line connecting them = intercristal (Tuffier's) line; intersection of the Tuffier's line and lumbar spine midline = L4 spinous process.]]
	*Suspicion of [[meningitis]] <ref>[http://www.cdc.gov/meningitis/lab-manual/chpt05-collect-transport-specimens.html CDC: Meningitis]</ref>		*Suspicion of [[meningitis]] <ref>[http://www.cdc.gov/meningitis/lab-manual/chpt05-collect-transport-specimens.html CDC: Meningitis]</ref>
	*Suspicion of [[subarachnoid hemorrhage]] (SAH) <ref>Carley, S. Harrison, M. Timing of lumbar puncture in suspected subarachnoid haemorrhage. Emerg Med J 2005;22:121-122</ref>		*Suspicion of [[subarachnoid hemorrhage]] (SAH) <ref>Carley, S. Harrison, M. Timing of lumbar puncture in suspected subarachnoid haemorrhage. Emerg Med J 2005;22:121-122</ref>
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	==Procedure==		==Procedure==
	~~[[File:PMC3425284 IJA-56-250-g001.png\|thumb\|Lateral patient positioning for LP.]]~~
	#Ultrasound can be used, especially on high BMI patients. Ultrasound videos [https://vimeo.com/63377229 one], [https://www.youtube.com/watch?v=ndnZxAcNjdg two], and [https://www.youtube.com/watch?v=rbbpwE_ijm0 three]. Routine use of Ultrasound, however, has not been shown to increase procedural success, use in specific scenarios only<ref>Review: Ultrasound-Assisted Lumbar Puncture (LP) Does Not Increase Procedural Success But Reduces Traumatic LPs Kirschner, J.M., et al, Ann Intern Med 170(2):JC9, January 15, 2019</ref>		#Ultrasound can be used, especially on high BMI patients. Ultrasound videos [https://vimeo.com/63377229 one], [https://www.youtube.com/watch?v=ndnZxAcNjdg two], and [https://www.youtube.com/watch?v=rbbpwE_ijm0 three]. Routine use of Ultrasound, however, has not been shown to increase procedural success, use in specific scenarios only<ref>Review: Ultrasound-Assisted Lumbar Puncture (LP) Does Not Increase Procedural Success But Reduces Traumatic LPs Kirschner, J.M., et al, Ann Intern Med 170(2):JC9, January 15, 2019</ref>
	#Sterile prep L3-L4 and L4-L5 interspaces; prepare and confirm correct tubes in numerical order		#Sterile prep L3-L4 and L4-L5 interspaces; prepare and confirm correct tubes in numerical order

Rossdonaldson1 at 23:00, 7 June 2023

2023-06-07T23:00:16Z

← Older revision		Revision as of 23:00, 7 June 2023
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	==Overview==		==Overview==
	[[File:Pediatric vs adult LP.jpg\|thumbnail\|Comparison of pediatric and adult spinal cord anatomy.]]		[[File:Pediatric vs adult LP.jpg\|thumbnail\|Comparison of pediatric and adult spinal cord anatomy.]]
	[[File:Pediatric_spinal_cord.JPG\|thumbnail]]		[[File:Pediatric_spinal_cord.JPG\|thumbnail\|Anatomic landmarks for lumbar puncture.]]

	==Indications==		==Indications==

Rossdonaldson1 at 22:59, 7 June 2023

2023-06-07T22:59:37Z

← Older revision		Revision as of 22:59, 7 June 2023
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	==Overview==		==Overview==
	[[File:Pediatric vs adult LP.jpg\|thumbnail]]		[[File:Pediatric vs adult LP.jpg\|thumbnail\|Comparison of pediatric and adult spinal cord anatomy.]]
	[[File:Pediatric_spinal_cord.JPG\|thumbnail]]		[[File:Pediatric_spinal_cord.JPG\|thumbnail]]

Rossdonaldson1 at 22:41, 7 June 2023

2023-06-07T22:41:48Z

← Older revision		Revision as of 22:41, 7 June 2023
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	==~~Background~~==		==Overview==
	[[File:Pediatric vs adult LP.jpg\|thumbnail]]		[[File:Pediatric vs adult LP.jpg\|thumbnail]]
	[[File:Pediatric_spinal_cord.JPG\|thumbnail]]		[[File:Pediatric_spinal_cord.JPG\|thumbnail]]
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	*[[Post-Lumbar Puncture Headache]]		*[[Post-Lumbar Puncture Headache]]
	*[[Spinal epidural hematoma]]		*[[Spinal epidural hematoma]]

			==See Also==
			*[[Meningitis]]
			*[[CT Before Lumbar Puncture]]
			*[[Procedure sample documentation]]

	==External Links==		==External Links==
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	*Neonatal		*Neonatal
	**Sachetti (5:44) https://www.youtube.com/watch?v=xvVIhFZeUnY&list=UUHaNQfnfpRdsqMdEBLlFaCw&index=21&feature=plcp		**Sachetti (5:44) https://www.youtube.com/watch?v=xvVIhFZeUnY&list=UUHaNQfnfpRdsqMdEBLlFaCw&index=21&feature=plcp

	~~==See Also==~~
	*[[Meningitis]]
	*[[CT Before Lumbar Puncture]]
	*[[Procedure sample documentation]]

	==References==		==References==

Rossdonaldson1 at 22:39, 7 June 2023

2023-06-07T22:39:57Z

← Older revision		Revision as of 22:39, 7 June 2023
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			==Background==
			[[File:Pediatric vs adult LP.jpg\|thumbnail]]
			[[File:Pediatric_spinal_cord.JPG\|thumbnail]]

	==Indications==		==Indications==
	[[File:Sagittal section LP.jpg\|thumb\|Proper needle trajectory: skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space (containing internal vertebral venous plexus), dura, arachnoid, and subarachnoid space]]		[[File:Sagittal section LP.jpg\|thumb\|Proper needle trajectory: skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space (containing internal vertebral venous plexus), dura, arachnoid, and subarachnoid space]]
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	#Opening pressure should be measured with patient on side with legs extended		#Opening pressure should be measured with patient on side with legs extended
	#Collect 1mL of CSF in each tube		#Collect 1mL of CSF in each tube
	~~[[File:Pediatric vs adult LP.jpg\|thumbnail]]~~
	~~[[File:Pediatric_spinal_cord.JPG\|thumbnail]]~~

	==CSF Studies==		==CSF Studies==

Rossdonaldson1 at 22:38, 7 June 2023

2023-06-07T22:38:42Z

← Older revision		Revision as of 22:38, 7 June 2023
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	==Procedure==		==Procedure==
			[[File:PMC3425284 IJA-56-250-g001.png\|thumb\|Lateral patient positioning for LP.]]
	#Ultrasound can be used, especially on high BMI patients. Ultrasound videos [https://vimeo.com/63377229 one], [https://www.youtube.com/watch?v=ndnZxAcNjdg two], and [https://www.youtube.com/watch?v=rbbpwE_ijm0 three]. Routine use of Ultrasound, however, has not been shown to increase procedural success, use in specific scenarios only<ref>Review: Ultrasound-Assisted Lumbar Puncture (LP) Does Not Increase Procedural Success But Reduces Traumatic LPs Kirschner, J.M., et al, Ann Intern Med 170(2):JC9, January 15, 2019</ref>		#Ultrasound can be used, especially on high BMI patients. Ultrasound videos [https://vimeo.com/63377229 one], [https://www.youtube.com/watch?v=ndnZxAcNjdg two], and [https://www.youtube.com/watch?v=rbbpwE_ijm0 three]. Routine use of Ultrasound, however, has not been shown to increase procedural success, use in specific scenarios only<ref>Review: Ultrasound-Assisted Lumbar Puncture (LP) Does Not Increase Procedural Success But Reduces Traumatic LPs Kirschner, J.M., et al, Ann Intern Med 170(2):JC9, January 15, 2019</ref>
	#Sterile prep L3-L4 and L4-L5 interspaces; prepare and confirm correct tubes in numerical order		#Sterile prep L3-L4 and L4-L5 interspaces; prepare and confirm correct tubes in numerical order

Rossdonaldson1 at 22:37, 7 June 2023

2023-06-07T22:37:49Z

← Older revision		Revision as of 22:37, 7 June 2023
Line 1:		Line 1:
	==Indications==		==Indications==
			[[File:Sagittal section LP.jpg\|thumb\|Proper needle trajectory: skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space (containing internal vertebral venous plexus), dura, arachnoid, and subarachnoid space]]
			[[File:Lumbar puncture lines.png\|thumb\|Surface markings for lumbar puncture. Blue dots = Iliac crests; line connecting them = intercristal (Tuffier's) line; intersection of the Tuffier's line and lumbar spine midline = L4 spinous process.]]
	*Suspicion of [[meningitis]] <ref>[http://www.cdc.gov/meningitis/lab-manual/chpt05-collect-transport-specimens.html CDC: Meningitis]</ref>		*Suspicion of [[meningitis]] <ref>[http://www.cdc.gov/meningitis/lab-manual/chpt05-collect-transport-specimens.html CDC: Meningitis]</ref>
	*Suspicion of [[subarachnoid hemorrhage]] (SAH) <ref>Carley, S. Harrison, M. Timing of lumbar puncture in suspected subarachnoid haemorrhage. Emerg Med J 2005;22:121-122</ref>		*Suspicion of [[subarachnoid hemorrhage]] (SAH) <ref>Carley, S. Harrison, M. Timing of lumbar puncture in suspected subarachnoid haemorrhage. Emerg Med J 2005;22:121-122</ref>
	*Suspicion of certain central nervous system (CNS) diseases such as [[Guillain-Barré syndrome]] <ref>Petzold A, Brettschneider J, Jin K, et al. CSF protein biomarkers for proximal axonal damage improve prognostic accuracy in the acute phase of Guillain-Barré syndrome. Muscle Nerve. 2009 Jul. 40(1):42-9</ref>		*Suspicion of certain central nervous system (CNS) diseases such as [[Guillain-Barré syndrome]] <ref>Petzold A, Brettschneider J, Jin K, et al. CSF protein biomarkers for proximal axonal damage improve prognostic accuracy in the acute phase of Guillain-Barré syndrome. Muscle Nerve. 2009 Jul. 40(1):42-9</ref>
	*Therapeutic relief of [[pseudotumor cerebri]] <ref>Chern JJ, Tubbs RS, Gordon AS, Donnithorne KJ, Oakes WJ. Management of pediatric patients with pseudotumor cerebri. Childs Nerv Syst. 2012 Jan 19</ref>		*Therapeutic relief of [[pseudotumor cerebri]] <ref>Chern JJ, Tubbs RS, Gordon AS, Donnithorne KJ, Oakes WJ. Management of pediatric patients with pseudotumor cerebri. Childs Nerv Syst. 2012 Jan 19</ref>

	[[File:Sagittal section LP.jpg\|thumb\|Proper needle trajectory: skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space (containing internal vertebral venous plexus), dura, arachnoid, and subarachnoid space]]
	[[File:Lumbar puncture lines.png\|thumb\|Surface markings for lumbar puncture. Blue dots = Iliac crests; line connecting them = intercristal (Tuffier's) line; intersection of the Tuffier's line and lumbar spine midline = L4 spinous process.]]

	==Contraindications==		==Contraindications==

Rossdonaldson1 at 22:35, 7 June 2023

2023-06-07T22:35:55Z

← Older revision		Revision as of 22:35, 7 June 2023
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	*Therapeutic relief of [[pseudotumor cerebri]] <ref>Chern JJ, Tubbs RS, Gordon AS, Donnithorne KJ, Oakes WJ. Management of pediatric patients with pseudotumor cerebri. Childs Nerv Syst. 2012 Jan 19</ref>		*Therapeutic relief of [[pseudotumor cerebri]] <ref>Chern JJ, Tubbs RS, Gordon AS, Donnithorne KJ, Oakes WJ. Management of pediatric patients with pseudotumor cerebri. Childs Nerv Syst. 2012 Jan 19</ref>

	[[File:Sagittal section LP.~~png~~\|thumb\|Proper needle trajectory: skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space (containing internal vertebral venous plexus), dura, arachnoid, and subarachnoid space]]		[[File:Sagittal section LP.jpg\|thumb\|Proper needle trajectory: skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space (containing internal vertebral venous plexus), dura, arachnoid, and subarachnoid space]]
	[[File:Lumbar puncture lines.png\|thumb\|Surface markings for lumbar puncture. Blue dots = Iliac crests; line connecting them = intercristal (Tuffier's) line; intersection of the Tuffier's line and lumbar spine midline = L4 spinous process.]]		[[File:Lumbar puncture lines.png\|thumb\|Surface markings for lumbar puncture. Blue dots = Iliac crests; line connecting them = intercristal (Tuffier's) line; intersection of the Tuffier's line and lumbar spine midline = L4 spinous process.]]

Rossdonaldson1: /* External Links */

2021-02-18T17:19:16Z

External Links

← Older revision		Revision as of 17:19, 18 February 2021
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	==External Links==		==External Links==
	*[http://jama.jamanetwork.com/data/Journals/JAMA/5048/JRC60004.pdf Straus, S. et al. How Do I Perform a Lumbar Puncture and Analyze the Results to Diagnose Bacterial Meningitis?]		*[http://jama.jamanetwork.com/data/Journals/JAMA/5048/JRC60004.pdf Straus, S. et al. How Do I Perform a Lumbar Puncture and Analyze the Results to Diagnose Bacterial Meningitis?]

			===Videos===
			*Adult
			**NEJM (10:59) https://www.nejm.org/doi/full/10.1056/NEJMvcm054952
			**Mellick (3:14) https://www.youtube.com/watch?v=grpeEDBMrn8
			*Neonatal
			**Sachetti (5:44) https://www.youtube.com/watch?v=xvVIhFZeUnY&list=UUHaNQfnfpRdsqMdEBLlFaCw&index=21&feature=plcp

	==See Also==		==See Also==

Elcatracho: /* See Also */

2021-01-18T20:58:37Z

← Older revision		Revision as of 20:58, 18 January 2021
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	*[[Meningitis]]		*[[Meningitis]]
	*[[CT Before Lumbar Puncture]]		*[[CT Before Lumbar Puncture]]
			*[[Procedure sample documentation]]

	==References==		==References==