Post-dural puncture headache

puncture /punc·ture/ (-cher) the act of piercing or penetrating with a pointed object or instrument; a wound so made.

cisternal puncture puncture of the cisterna cerebellomedullaris through the posterior atlanto-occipital membrane to obtain cerebrospinal fluid.

lumbar puncture , spinal puncture the withdrawal of fluid from the subarachnoid space in the lumbar region, usually between the third and fourth lumbar vertebrae.

sternal puncture removal of bone marrow from the manubrium of the sternum through an appropriate needle.

ventricular puncture puncture of a cerebral ventricle for the withdrawal of fluid.

lumbar puncture

n. Abbr. LP

Puncture into the subarachnoid space of the lumbar region for diagnostic or therapeutic purposes. Also called rachicentesis, rachiocentesis, spinal puncture, spinal tap.

Lumbar puncture

A procedure in which the doctor inserts a small needle into the spinal cavity in the lower back to withdraw some spinal fluid for testing. Also known as a "spinal tap."

Mentioned in: Arteriovenous Malformations, Botulism, Central Nervous System Infections, Cryptococcosis, Leukemias, Chronic, Rabies, Subarachnoid Hemorrhage

lumbar puncture (LP),

a diagnostic or therapeutic procedure in which a hollow needle and stylet are introduced into the subarachnoid space of the lumbar part of the spinal canal to obtain cerebrospinal fluid (CSF). Strict aseptic technique is used. Diagnostic indications include measuring of CSF pressure; obtaining CSF for laboratory analysis; and injecting oxygen or a radiopaque substance for radiographic visualization of the structures of the nervous system of the spinal canal and meninges and brain. Therapeutic indications for lumbar puncture include removing blood or pus from the subarachnoid space, injecting sera or drugs, withdrawing CSF to reduce intracranial pressure, introducing a local anesthetic to induce spinal anesthesia, and placing a small amount of the patient's blood in the subarachnoid space to form a clot to patch a hole in the dura to prevent leak of CSF into the epidural space.

method The skin over the interspace of the third and fourth lumbar vertebrae is cleansed. A fenestrated sterile drape is placed over the back, the window over the puncture site. The needle is inserted through the interspace to the subarachnoid space, and the stylet is withdrawn. If the needle is in the proper place, clear, straw-colored CSF will begin to drip out through the needle. Depending on the indication for the procedure, various techniques follow. The pressure of the CSF may be measured with a manometer attached to a catheter and stopcock, or fluid may be withdrawn, visually examined, and sent to the laboratory for chemical or bacteriologic analysis.

interventions The nurse may be responsible for obtaining the patient's written permission for the physician to perform a lumbar puncture. If the patient is apprehensive, he or she may be given a sedative one-half hour before the procedure. The techniques to be used and the treatments to be given or the information to be obtained are explained. The patient is placed in a lateral recumbent position, the back as near the edge of the bed as possible. The legs are flexed on the thighs, the thighs are flexed on the abdomen, and the head and shoulders are bent down, curving the spine convexly to afford the greatest space between the vertebrae. If the patient is excessively hairy, a dry shave of the lumbar area is performed before draping the area. After the procedure, significant signs to be observed by the nurse include pain, change in mentation or alertness, leakage of CSF from the puncture site, fever, and urinary retention. The patient is usually kept flat in bed, often in a prone position, for 1 hour after the procedure.

outcome criteria Lumbar puncture is contraindicated if intracranial tumor is suspected and there is evidence of greatly increased intracranial pressure, if there are signs of infection at the site of puncture, or (to avoid a second puncture) if encephalography or myelography is planned in the near future. Infection, leakage of CSF, headache, nausea, vomiting, dysuria, or signs of meningeal irritation occur in approximately 25% of patients.

lumbar [lum´bahr]

pertaining to the loins.

lumbar puncture introduction of a hollow needle into the subarachnoid space of the spinal canal, usually between the fourth and fifth lumbar vertebrae; see also cisternal puncture. Called also spinal puncture.

It may be done for diagnostic purposes to determine the pressure within the cerebrospinal cavities, to determine presence of an obstruction to flow of cerebrospinal fluid, to remove a specimen of cerebrospinal fluid for laboratory examination, or to inject air or other contrast medium into the spinal canal to take an x-ray of the cerebrospinal system.

Patient Care. Before the procedure is begun the patient is given a simple explanation of the nature and purpose of the test and is told that there is no danger of damage to the spinal cord during a lumbar puncture because the spinal cord does not extend below the second lumbar vertebra. For a cisternal puncture, the back of the neck may be shaved.

The patient is positioned so that the knees and head are flexed as much as possible and is assisted in maintaining this position during the entire procedure. A local anesthetic is injected subcutaneously to anesthetize the skin and underlying tissues. The patient should be warned not to move suddenly and told there may be a slight feeling of pressure when the puncture needle is inserted.

Strict adherence to the rules of aseptic technique is necessary to avoid the possibility of introducing microorganisms into the spinal canal. The attendant may be asked to assist in the Queckenstedt test during the lumbar puncture. This test involves compression of the veins of the neck, first on one side, then on the other and finally on both sides at once. The cerebrospinal fluid pressure is measured each time the veins are compressed. This test determines whether there is an obstruction in the spinal canal. Care must be taken that the trachea is not constricted while the neck veins are being compressed.

After the procedure the patient is observed for signs of pulse changes, respiratory difficulty, or cyanosis. These rarely occur, but headache is common and may be partially relieved by keeping the patient flat in bed for 8 hours after the procedure. An ice cap and aspirin may help alleviate the discomfort.

Technique of lumbar puncture. Needle is inserted between vertebrae and advanced through dura mater to the subarachnoid space. Cerebrospinal fluid is thus withdrawn from the spinal cavity.

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