Lumbar Puncture PRINT

Lumbar Puncture (printer friendly)

Lumbar Puncture Myelogram Questionnaire

I. Pre-Procedure Technologist Checklist:

a. ED and Inpatients

i. Head CT or MRI current admission
ii. Pts with history of anticoagulation therapy

1. Follow medication guidelines
2. INR <1.5, Platelets >50,000

b. Outpatients

i. Follow medication guidelines (PLT, INR not required)
ii. Must have a driver

c. All Patients

i. Hydrate prior to exam
ii. Should be able to lay prone and hold still for exam
iii. Must provide consent (patient/POA) (emergent Dr. to Dr. consent last resort)
iv. Labs orders verified

II. Equipment

a. Lumbar puncture tray
b. 5 or 10cc syringe
c. 25g 1.5” needle
d. 22g spinal needle
e. Hemostat (non-sterile)/marker
f. Lab bag for CSF vials
g. Patient stickers

III. Medications

a. Lidocaine 1%
b. Intrathecal chemotherapy medications (document medication in draft)

IV. Personnel

a. Radiologist/RA

i. Verify the order
ii. Enter pre and post procedure orders
iii. Verify laboratory results: INR <1.5, Platelets >50,000
iv. Review risks, aftercare instruction and obtain consent from the patient/POA prior to positioning patient

b. Technologist

i. Print order and reviews with rad/RA
ii. Fills out Technologist Lumbar Puncture/ Myelogram Questionnaire
iii. Coordinates chemo injections w/ pharmacy and chemo certified nurse

V. Procedure

a. Patient is placed in the prone position on table
b. Timeout: include INR, platelets, allergies, anticoagulants, verify orders: CSF, blood, opening pressure
c. Radiologist/RA will mark puncture site under fluoroscopy
d. Lower back is prepped and draped in sterile fashion
e. Lumbar puncture is done under intermittent fluoroscopy guidance
f. Collect 8-12cc of CSF (20cc’s for large volume/NPH)
g. Remove needle with stylet in place
h. Post procedure care is site dependent (technologist delivers CSF to lab)

VI. Required Images

a. Screen capture image of needle location

VII. Special Considerations

a. a. Opening pressure (document opening and closing pressure in report)

i. in prone position: add needle length to measurement
ii. When a C-arm is available, the needle can be placed in the lateral decubitus position
iii. Lutheran- Pressure to be measured using long extension tubing and compass. Hold compass at pt’s side (mid-body)

b. For intrathecal chemotherapy injections, the radiologist/RA will perform the puncture

i. Radiologist/oncologist injecting chemotherapy will verify orders, by matching the chemotherapy label with the patient’s wrist band, prior to injection