Lumbar puncture or spinal tap is an invasive and aseptic procedure in which a needle is inserted into the sub arachnoid space of the lumbar region. The nurse takes care in the preparation, assists the paediatrician during the procedure and manages the child after the procedure.
Aims
· Decrease fear and anxiety among the child, caregiver/family
· Evaluate cerebrospinal fluid for infections such as Encephalitis and Meningitis
· Introduce contrast medium for investigations
· Infuse medication for treatment and anaesthesia
· Lessen potential complications post-lumbar puncture
· Manage complications
· Diagnostic purposes
Types
· Preparation
· During the procedure
· Post-procedure
Requirements
a. Sterile gloves
b. Lumbar puncture needle with stylet (22 gauge for young infant; 20 gauge for an older infant or child)
c. Consent form
d. Povidine iodine
e. Syringes and needles (5ml)
f. Sterile cotton wool swabs
g. Collection tubes/specimen bottle
h. Adhesive tape or plaster
i. Sterile dressing pack
j. Resuscitative equipment e.g. suction apparatus, oxygen source, bag and mask
k. Sphygmomanometer and stethoscope
l. Anaesthetic agents e.g. Lignocaine 1%
m. Sterile drape and mask
n. Macintosh with sterile towel/bed mat
Steps
1. Establish rapport (refer steps)
2. Explain procedure to caregiver/family (refer steps)
3. Ensure that informed consent form has been signed by parent/caregiver
4. Allow caregiver to make a decision of staying or leaving the procedure area
5. Perform hand hygiene, disinfect and set trolley
6. Ensure child empty bladder and bowel
7. Check and record vital signs; temperature, pulse, respiration, BP and pain
8. Assess neurological status using Blantyre Coma Scale or AVPU Scale
9. Place the child on a firm flat surface
10. Provide privacy
11. Undress the child when ready for the procedure
12. Put child in lateral decubitus position (child’s knees are drawn up towards the chest and shoulders; lying position particularly for young infant)
13. Curve the head towards the knees sits the child on the edge of the bed (particularly for older children)
14. Make child lean over the bed side table for support (for older children)
15. Ensure the child’s neck is partially extended and not flexed to obstruct airway
16. Assist paediatrician to clean and drape the site for insertion
17. Support child to remain still throughout the procedure
18. Assist paediatrician to infiltrate the site with anaesthetic agent
19. Monitor general condition of the child as the spinal needle is inserted between the 3rd -5th lumber vertebrae
20. Assist the paediatrician to take the sample or instill medication where necessary
21. Reassure child/caregiver intermittently
22. Apply brief pressure to the punctured site with sterile dressing and adhesive plaster
23. Place child on flat/ recumbent position for at least 1 hour
24. Monitor vital signs, neurological status and intake and output at least every 4 hours for 24 hours
25. Report any leakage of CSF and blood around the site to the Ward Manager and the Paediatrician
26. Monitor for headache, vomiting, neck stiffness, sense of imbalance etc.
27. Encourage increase flowing intake
28. Give prescribed analgesics
29. Dispose off, decontaminate and clean used items
30. Appreciate the child/caregiver for their cooperation
31. Document findings and procedure
32. Label specimen and send to the laboratory where necessary
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