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 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