How to do a lumbar puncture

In this video, from our Emergency Procedures Masterclass (Part I) course, we'll simplify the lumbar puncture procedure and explain it in full. Master this procedure to help you diagnose a brain bleed or infection in an emergency situation!

Perform emergency procedures like a pro! With our Emergency Procedures Masterclass (Part I) course, you'll get the lowdown on the tools involved in each treatment or diagnostic procedure, when and how to perform them, and how to anticipate and minimize complications.

Preparing for a lumbar puncture

[0:00]
Here's a video demonstrating the lumbar puncture [LP] procedure, starting from the point where the skin has already been anesthetized. We're going to indent the skin with the back of a needle cap and use the small needle to anesthetize the skin. Now, this is a mannequin, so you won't be able to see the blood, and you can't see the wheal. We're going to change the needle to the longer needle to anesthetize the deeper tissues.

Introducing the spinal needle and confirming cerebrospinal flow

[0:43]
Spinal needle is introduced with a slight angle aimed towards the patient's belly button. And once you feel a little pop right there, you're going to take out the stylet and see if there's flow of CSF [cerebrospinal fluid]. It sure is. So, we're going to put the stylet back in and get the manometer ready.

Measuring opening pressure with a lumbar puncture manometer

[1:03]
The dial of the manometer is closed towards you so that the fluid will come through the needle and go up, up, up. At this point, I have seen what the opening pressure is, so I'm going to turn the dial towards the patient, and the CSF will flow down into the tube.

Collection of CSF samples

[1:32]
Now, I've chosen to just take the whole manometer off and collect 1 cc in each of the tubes. There's a total of four tubes, 1 cc for each tube. What you see is, with one hand, I fill the tube, and with the other, I close the cap. It's okay if some of it drips, like I drip there. 

Completing the lumbar puncture procedure

[2:11]
Before taking the LP needle out, we're going to put the stylet back in to decrease the chances of a post-LP headache. I'm going to take the needle out and put our bandage on. Here, we have completed our lumbar puncture.