Considerations for Performing Lumbar Puncture (LP)

Considerations for Performing Lumbar Puncture (LP)

Considerations for Performing Lumbar Puncture (LP)

Assess Patient Characteristics That May Increase
Risk of Lumbar Puncture (LP)
Assess need for sedation or general anesthesia
Sedation or
anesthesia needed
  • Sedation or Anesthesia Needed
  • Consult Sedation Team
  • Or
  • Consult Anesthesia Resource Center (ARC)
  • Call OR Board Runner, 5-4444 to schedule
  • Requires Attending with OR privileges
  • Ensure 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
  • Weekdays: 8 a.m. - 4 p.m., call 53255
  • Nights, weekends, holidays: 4 p.m. - 8 a.m., page IR attending on-call