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1min To introduce the Introduction:

topic. I am Mary and I
am going to give
demonstration
teaching on
Lumbar Puncture.

The cerebrospinal
fluid is formed
through the chorio
villi, in each of the
four ventricles of
the brain and it
circulates freely
through the
ventricles, the
subarachnoid space
and the central
canal of the spinal
cord. It is then
absorbed into the
venous circulation
via superior sagittal
sinus.
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During development vertebral column outgrows the spinal cord ends at the lower
border of the lumber vertebra, but in the newborn infant it ends slightly at the lower
level at the level of the third lumbar vertebra. The dural and arachnoid sacs extend up
to the level of the second sacral vertebra and this cavity contains the CSF. Thus the
region between the second vertebra and the second sacral vertebra is suitable for the
withdrawal of CSF, as there is no danger of injury to the spinal cord.

2mins Define lumbar Definition

puncture. A lumbar puncture is the insertion of a needle into the lumbar region of the spine a Student teacher What is the
manner that the needle enters the lumbar arachnoid space of the spinal canal below the defines about definition of
level of the spinal cord, so that the cerebrospinal fluid can be withdrawn. lumbar puncture. lumbar puncture?

3mins List the purposes Student teacher What are purpose

Purpose of Lumbar Puncture
of lumbar puncture lists down the for lumbar
purposes of lumbar puncture?
- To administer spinal anesthesia before surgery in the lower half of the body.
puncture.
- To administer medication into the spinal cord as in the case of meningitis.
- To remove fluid (CSF, blood pus etc.) contained in the subarachnoid spaces,
thereby reducing the intracranial pressure.
- To remove a sample of CSF for laboratory examinations in order to diagnose
disease.
- To measure the pressure of CSF and to determine whether the lumbar
subarachnoid spaces is in communication with the ventricles of the brain.
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2mins List the samples Samples collected to be studied on: Student teacher What are the
collected in lumbar lists down the samples that are
puncture. Tube 1 (Microbiology): Gram’s stain, Crypto antigen, bacterial/fungal/mycobacterial samples which are taken in lumbar
cultures, PCR tests. Cell count and differential if bloody. collected during puncture?
lumbar puncture.
Tube 2: Cytology (if indicated) or hold for add-on studies.

Tube 3 (Chemistry/Immunology): Protein, glucose, CSF immunoglobulin index

(requires paired serum sample).

Tube 4 (Hematology): Cell count with differential.

Site of the Lumbar Puncture and positioning of the patient. Student teacher Which site is
Explain the site for explains the site for taken for Lumbar
lumbar puncture -In lumbar puncture a needle is inserted into the lumbar area (L3- L4) is preferred site lumbar puncture. puncture?
of the subarachnoid space.

-The patient is placed in a side lying position at the edge of the table or bed. The
patient’s body should be in the fetal attitude (C shaped) with full flexion of the spine.

-In the neonate, the sitting position may place one hand behind the child’s neck or one
arm around the neck and grasp the legs, while placing the other arm around the
buttocks and grasping the hands.
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2mins List the articles Preparation of the Articles. Student teacher What articles are
required for lumbar lists down the needed for lumbar
puncture. A sterile tray containing: article’s for lumbar puncture?
puncture
- LP needles-2 sizes with their stillet.
- Sponge holding forceps
- Syringe (5ml) with needles to give anesthesia.
- Small bowl to take cleaning lotion (betadine)
- Bottle of spirit
- Specimen bottle
- Cotton balls, gauze pieces and cotton pads
- Gloves, gown and masks
- Dressings towels or slit towel
- Mackintosh and towel.
- Kidney tray and paper bag
- Lignocaine 2%
- Normal saline
- Adhesive plaster and scissors
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Enlist the General Instructions: Student teacher What should be

instructions needed enlists general instructions are to
during the 1. A strict aseptic technique to be followed instructions during be carried out
procedure. 2. The child should be placed in a position that will widen the inter vertebral the procedure. during the
space. procedure?
3. Uncooperative patients and children can be restrained during the procedure.
4. The patient should be placed near the edge of the bed.
5. The LP needles should be sharp, small in size and not curved.
6. After the Lumbar puncture, the patient should lie flat on the bed.
7. The CSF collected should be sent to the laboratory without any delay.
8. Drugs to be injected must be warmed to body temperature and it should be
injected very slowly.

Explain the
Preparation of the patient:
Student teacher How to prepare
preparation of the explains the the client for
1. Explain the procedure to the parents.
client preparation of the lumbar puncture?
2. Monitor vitals before the procedure.
client.
3. Prepare the skin as for surgical procedure. Skin is disinfected with spirit and
iodine just before doing the spinal puncture.
4. Put on clean and lose garments.
5. Arrange the articles at the bedside table.
6. Fold back the upper garments above the waistline and the lower garments
below the hip.
7. Protect the bed with mackintosh.
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7mins Describe after the After Care of the procedure Student teacher Explain the care
care of the describes after the of the procedure.
procedure. 1. As soon as the needle is withdrawn, seal the puncture site with a Tincher care of the
benzoin dressing to prevent leakage of CSF. procedure.
2. Place the child comfortable on the bed in a supine position for 12 to 24 hours.
3. Check for the blood sugar level of the patient.
4. If the patient develops post puncture headache, the following precautions are
taken.
5. Darken the room, provide a calm environment.
6. Give plenty of oral fluids
7. Administer analgesics.
8. Raise the foot end of the bed.
9. Watch for the patient’s color, pulse, respiration, blood pressure and other signs
of complications.
10. Record the procedure on the patient’s chart with date and time.
11. The specimens of the CSF collected should be sent to the laboratory without
any delay with proper labels and requisition form.
12. If there are no complications observed, the patient may be allowed to upright
after 8 to 12 hours.
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5mins List the Complications Student teacher list What are the
complications in down the complications of
lumbar puncture complications of lumbar puncture?
1. Injury to the spinal cord and spinal nerves
2. Infection introduced to the spinal cavity which may give rise to meningitis. lumbar puncture.
3. Leakage of CSF through the puncture site and lowering the intracranial
pressure and may cause post puncture headaches.
4. Damage to the inter vertebral disc.
5. Local pain, edema and hematoma at the puncture site.
6. Temperature elevation
7. Rapid reduction in the intra cranial space.

Summary:
At the end of the topic I summarize it and I have discussed about introduction,
definition, purposes, samples which are taken, site and positioning, preparation of the
articles, care after procedure and complications.

Conclusion:
I hope all have understood my topic. Thank you all for your cooperation.

Bibliography:
Nancy Sr. “Principles and Practice of Nursing”, Vol 2 , N.R publishing house.
Trained Nurses Association Of India, “Fundamentals of Nursing- A Procedure
Manual” , First Edition, Published by secretary- general on behalf of TNAI.
IDENTIFICATION DATA

NAME : MARY MENU EKKA

CLASS : M.Sc. 2nd YEAR

SUBJECT : CHILD HEALTH NURSING

TOPIC : LUMBAR PUNCTURE

DATE OF PRESENTATION :

PLACE : CLINICALS

TIME : 30 MINS.

METHOD OF TEACHING : LECTURE CUM DISCUSSION, DEMONTRATION

SUPERVISOR : MS. JIBANLATA

AV AIDS : CHARTS, FLASH CARDS

GROUP :
PREVIOUS KNOWLWDGE OF THE STUDENTS:
Students may have some knowledge about the Cerebrospinal fluid.

SPECIFIC OBJECTIVES:

- Introduce the topic.

- Define lumbar puncture.
- List the purposes of lumbar puncture.
- List the samples collected in lumbar puncture.
- Explain the site for lumbar puncture.
- List the articles required for lumbar puncture.
- Enlist the instructions needed during the procedure.
- Explain the preparation of the client.
- Demonstrate the procedurre
- Describe after the care of the procedure.
- List the complications in lumbar puncture.

GENERAL OBJECTIVES:

Group point of view:

At the end of the teaching session the group will be able to

 Gain knowledge about the topic lumbar puncture.
 Able to assess the conditions in the clinical areas.

Student teacher point of view:

 Teach the group effectively.

 Realize the cognitive functions.
 Develop and improve professional efficiency.
 HOLY FAMILY COLLEGE OF NURSING
NEW DELHI.

DEMONTRATION
ON
LUMBAR PUNCTURE

SUBMITTED TO: SUBMITTED BY:

MS. JIBANLATA MARY MENU EKKA
ASSOCIATE PROFFESOR. M.Sc. 2ND YEAR NURSING STUDENT.
HOLY FAMILY COLLEGE OF NURSING

Submitted on:
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10mins Demonstrate the STEPS RATIONALE Student teacher Explain the

procedure. demonstrates the procedure of
Explain the procedure to the To reassure the patient and gain his co-operation procedure lumbar puncture.
procedure. (if adult child) or explain it to the parents. This
promote a sense of trust and lack of confusion.

Position of the child

a. Position of the child in a It offers maximum widening of inter-spinal
side lying position, spaces and provides an easy entry to sub
towards the end of the arachnoid space in the lumbar region.
bed (preferably right)
and make the child lie in
a “C” position.

b. Spread the mackintosh To protect the linen.

and the towel on the bed
below the puncture site.

c. Wash hands Helps to control infection.

Performance Phase (by the

physician)

d. Clean the site spirit and Antiseptic solution helps to prevent it from entry
betadine and spread the of infection.
spinal sheet.
e. The skin and Local anaesthesia reduces the sensation of pain.
subcutaneous space is
infiltrated with a local
anaesthetic agent.

f. Assist the physician by L3-L4 is below the level of spinal cord and the
accurate identification of most suitable place where more space of
L3 and L4 intervertebral intervertebral space is found.
spaces.

g. Insert the needle in the

spinal space. For sample collection and for investigation.

h. Collect the 2-3 ml of

spinal in each of the Prevents in the leakage of the CSF fluid.
labelled bottles.

i. After needle is
withdrawn apply Prevents the leakage of C.S.F fluid and entry of
pressure at the site for a micro organisms.
few minutes.

j. Apply Band aid or seal

the site by applying
tincture benzoin or apply
sterile dressing. To prevent headache due to the fall in the C.S.F
pressure. Prevents from complication.
k. Place the child
comfortable on the bed
in a supine position for
12 to 24 hours.
l. Observe the puncture Early detection helps in prevent any
site for any leakage of complication; CSF leakage can decrease the CSF
CSF or localized pressure.
infection.

m. After care of articles

- Wash the articles in To prevent cross infection.

running water.
- Replace the articles in To get ready for next use.
L.P tray and send for
sterilization.
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