Lumbar puncture or lumbar puncture is a procedure of taking cerebrospinal and spinal fluid. This procedure is done by sticking a needle into the spinal opening in the lower back.
Lumbar puncture procedures are usually used for examining diseases of the brain and spinal cord, such as meningitis or multiple sclerosis. This procedure can also be done to insert drugs directly into the brain or spinal cord.
LP can be done on adults, infants, and children. However, patients who are pregnant, are allergic to drugs, or who are taking certain medications, such as blood-thinning drugs, need to inform their doctor before performing this procedure.
Purpose and indication of lumbar puncture (LP)
The lumbar puncture procedure can be done as a method of diagnosis or treatment. Following are some of the objectives of this procedure:
- Taking cerebrospinal fluid samples to detect a disease.
- See the pressure inside the head cavity and spine.
- Inserting drugs into the nervous system, such as drugs or chemotherapy drugs.
- Inserting a dye or radioactive substance into the cerebrospinal fluid before scanning.
Examination of cerebrospinal fluid samples
Examination of brain and spinal cord (cerebrospinal fluid) samples through lumbar puncture is useful for detecting abnormalities in the nervous system, such as infection, bleeding, or cancer. Some diseases that can require lumbar puncture to diagnose are:
- Meningitis
- Encephalitis
- Tumors of the brain and spinal cord
- Subarachnoid hemorrhage
- Reye's Syndrome
- Myelitis
- Neurosyphilis
- Guillain-Barre syndrome
- Multiple sclerosis
Warnings Before Performing Lumbar Puncture (LP)
Before a lumbar puncture is performed, the patient needs to inform the doctor if he has or has had a blood clotting problem. This is so the doctor can anticipate complications that may occur.
Because the anesthetic will be given before a lumbar puncture is performed, the patient also needs to tell the doctor if he is allergic to certain anesthetics, to prevent an allergic reaction to the drug.
Patients need to inform the doctor if they are using blood-thinning drugs, such as aspirin or warfarin. Blood thinning drugs can cause bleeding when a lumbar puncture procedure is performed. Therefore, the doctor will usually ask the patient to stop taking the drug a few days before.
Preparation Before Lumbar Puncture (LP)
At the beginning of the examination, the doctor will ask about the patient's medical history and do a physical examination. The doctor will also carry out several investigations, such as blood tests, CT scans, or MRIs, if needed.
Patients are advised to increase fluid intake by increasing drinking water, since 2 days before the lumbar puncture procedure is performed. The patient also needs to fast for 3 hours before the procedure, but is still permitted to drink water.
For safety and comfort reasons, patients should be accompanied by family or relatives because they are not permitted to bring vehicles 24 hours after the procedure. Patients are also not advised to use public transportation alone.
Patients should arrive at the hospital 1 hour before the procedure is done to prepare themselves. Patients will be asked to change clothes to hospital clothes that have been provided. Therefore, patients should wear clothes and footwear that are easily removable.
Patients will also be asked to remove all jewelry used, including earrings. To make it easier, patients should not wear any accessories or jewelry from home.
Procedures and Measures for Lumbar puncture (LP)
The following are the steps carried out in the procedures and actions of the lumbar puncture:
Positioning the patient during the lumbar puncture procedure
The patient is asked to go up to the examination table and lie on his side, the chin is brought close to the chest, and the knee is brought close to the stomach.
The patient can also sit with the body leaning forward or hugging a pillow. These positions make the space between the spine wider.
Anesthetics on the lower back
Before injecting the anesthetic, the patient's lower back will be cleaned with antiseptic fluid and coated with a sterile cloth.
Then the doctor will inject a local anesthetic into the lower back to numb the part of the body that will be inserted into the needle. Anesthetic injection will feel painful, but can relieve pain during the LP procedure.
Lumbar puncture action
The neurologist will stick a needle into the spinal opening in the lower back. During the needle entry process, the patient is not allowed to move. After the needle has entered the desired limit, the patient will be asked to change position so that brain fluid and spinal cord can come out.
The next action depends on the purpose of the LP. The doctor can measure the pressure inside the spinal cavity, take fluid samples, or inject drugs. Then the needle will be removed and the injection hole will be closed with a bandage.
This procedure usually takes 30-45 minutes. Although there is no pain during the LP procedure, the patient can still feel discomfort and pressure in the back during the needle sticking process.
The results of lumbar puncture examination can usually be seen 48 hours after the procedure is performed.
Recovery after lumbar puncture (LP)
After the procedure is complete, the patient will be asked to lie down for at least 1 hour under the supervision of a doctor. Patients may move as long as the head is not lifted from the bed. Usually patients must use a chamber pot if they want to urinate.
Bandages used to cover the injection hole should not be opened 24 hours after the procedure. Patients will be allowed to go home the same day after the body's condition has improved or can be treated if there are conditions that make it impossible to go home, for example with a suspected brain inflammation.
Patients are asked to avoid strenuous activities for 24 hours after lumbar puncture is performed. Patients can return to work immediately if the work does not require them to move too much.
Patients should drink more water to reduce the risk of headaches. To help relieve headaches, patients are advised to drink drinks that contain caffeine, such as tea, coffee, or soda.
Patients can also take painkillers containing paracetamol to reduce pain in the head and back. The drug must be used in accordance with the rules of use.
Complications and Side Effects of Lumbar Puncture (LP)
In general, lumbar puncture is safe to do. However, this procedure can also cause complications which include:
- Headache
- Discomfort or pain in the back
- Bleeding at the injection site
- Skin infections
- Difficulty urinating
- Numbness or tingling in the legs
Harmful and fatal side effects, such as rupture of blood vessels and displacement of the brain stem, can also occur. However, these complications are very rare.
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