Considerations for Performing Lumbar Puncture (LP)

Considerations for Performing Lumbar Puncture (LP)

Assess need for sedation or general anesthesia
Sedation or
Anesthesia needed
  • Sedation or Unsure if Sedation Needed
  • Provider
    • Orders Sedation Consult
    • Call Sedation Provider, 11733
  • Provider
    • Orders ARC Consult
      • Anesthesia Resource Center (ARC)
    • Call Board Runner, 5-4444 to schedule
    • Requires Attending with OR privileges
  • Assure NPO, COVID Testing
Assess need for image-guided LP in Interventional Radiology
Image-guided
Not-Image-guided
  • Order
  • “IR Lumbar Puncture, Diagnostic” Include if sedation/GA needed Consider discussion with IR attending on call for other indications and/or if procedure is urgent
  • Determine location of procedure if outside of ED:
    • Sedation unit if with sedation OR if with anesthesia
    • Treatment Room if no sedation/GA needed
  • Consider using topical lidocaine, injectable lidocaine, or a single dose of Versed to help
  • Indications for Image-Guided LP
  • Recent unsuccessful LP attempt
  • Abnormal anatomy making LP technically difficult
    • e.g. Severe scoliosis, hx spinal surgery, indwelling hardware
  • BMI > 35 or body habitus making LP difficult due to inability to identify landmarks
  • Consider discussion with IR Attending for other indications and/or if procedure is urgent
  • Note:
  • Use of sedation/general anesthesia alone is not an indication for image-guided LP
  • IR Contact
  • Weekday: 8 a.m.- 4 p.m., call 53255
  • Night, WE, holiday: 4p-8a, page IR attending on-call
  • IR Contact
  • Weekdays: 8 a.m. – 4 p.m Call 53255
  • 4p-8a, page IR Attending on Call
  • GA contact: 54444
  • Sedation contact: 11733