Lumbar puncture: position, preparation and monitoring
Before anything else: raised intracranial pressure must be excluded. Papilledema, a focal neurological deficit or a decreased level of consciousness are reasons to obtain imaging before the puncture, because removing fluid below an intracranial mass can cause herniation. Position: lateral decubitus with the back at the edge of the bed, knees drawn to the chest and chin tucked down, or seated leaning forward over a table. The aim is to open the intervertebral spaces. Holding the person in position, and explaining each step as it happens, is the nursing contribution that determines how well the procedure goes. Strict aseptic technique throughout. If cultures are ordered, note the order of the tubes and label them at the bedside. After: lie flat for the period prescribed and encourage fluids. Watch for post-puncture headache, which is typically positional, worse on sitting up and relieved by lying down. Report fever, neck stiffness, new back pain radiating down a leg, or leaking at the puncture site. Record the opening pressure if it was measured and the appearance of the fluid. Cloudy fluid is transmitted as an urgent finding.