Lumbar puncture or lumbar puncture is a procedure to take fluid from the spinal cord and brain (cerebrospinal). This procedure is carried out by feedingkright needle? to spinal cleft in back part lower.
The lumbar puncture procedure is usually used to check for diseases of the brain and spinal cord, such as meningitis or multiple sclerosis. This procedure may also be performed to insert medication directly into the brain or spinal cord.
LP can be performed on adults, infants, and children. However, patients who are pregnant, allergic to anesthetics, or who are taking certain medications, such as blood thinners, need to inform their doctor before performing this procedure.
Purpose and Indications for Lumbar Puncture (LP)
The lumbar puncture procedure can be performed as a method of diagnosis or treatment. The following are some of the purposes of this procedure:
- Taking a sample of cerebrospinal fluid to detect a disease.
- Look at the pressure in the cavity of the head and spine.
- Administering drugs into the nervous system, such as anesthetics or chemotherapy drugs.
- Inserting a dye or radioactive substance into the cerebrospinal fluid before performing the scan.
Cerebrospinal fluid sample examination
Examination of samples of brain fluid and spinal cord (cerebrospinal fluid) through a lumbar puncture is useful for detecting abnormalities in the nervous system, such as infection, bleeding, or cancer. Some of the diseases that may require a lumbar puncture to diagnose are:
- Tumors of the brain and spinal cord
- Subarachnoid hemorrhage
- Reye's syndrome
- Guillain-Barre syndrome
- Multiple sclerosis
Warning Before Performing a Lumbar Puncture (LP)
Before a lumbar puncture is performed, the patient needs to inform the doctor if he is or has ever had a blood clotting disorder. This is so doctors can anticipate complications that may occur.
Because anesthesia will be given before the 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 should inform their doctor if they are taking blood thinning drugs, such as aspirin or warfarin. Blood-thinning medications can cause bleeding during a lumbar puncture procedure. Therefore, the doctor will usually ask the patient to stop taking the drug a few days earlier.
Preparation Before Lumbar Puncture (LP)
During the initial examination, the doctor will ask the patient's medical history and perform a physical examination. The doctor will also perform several supporting tests, such as blood tests, CT scans, or MRIs, if needed. Doctors can also ask informed consent before performing a lumbar puncture.
Patients are advised to increase fluid intake by drinking more water, since 2 days before the lumbar puncture procedure. Patients also need to fast for 3 hours before the procedure, but are still allowed to drink water.
For reasons of safety and comfort, patients should be accompanied by family or relatives because they are not allowed to bring a vehicle for 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 to prepare themselves. Patients will be asked to change into hospital clothes that have been provided. Therefore, patients should wear clothing and footwear that is easily removable.
The patient will also be asked to remove all jewelry, including earrings. To make things easier, the patient should not wear any accessories or jewelry from home.
Lumbar Puncture (LP) Procedures and Procedures
The following are the steps performed in the lumbar puncture procedure and procedure:
Positioning the patient during the lumbar puncture procedure
The patient is asked to go up to the examination table and lie on his side, chin to chest, and knees to stomach.
The patient can also sit with the body leaning forward or hugging a pillow. These positions make the space between the spine wider.
Anesthesia for the lower back
Before injecting the anesthetic, the patient's lower back will be cleaned with an antiseptic solution and covered with a sterile cloth.
The doctor will then inject a local anesthetic into the lower back to numb the area of the body where the needle will be inserted. The anesthetic injection will sting, but can relieve pain during the LP procedure.
The neurologist will insert a needle into the spinal cleft in the lower back. During the needle insertion process, the patient is not allowed to move. After the needle is inserted to the desired level, the patient will be asked to change position so that the cerebrospinal fluid and spinal cord can exit.
The next action depends on the purpose of doing the LP. The doctor can measure the pressure inside the spinal cavity, take a sample of fluid, or inject medication. Then the needle will be removed and the injection hole will be covered with a bandage.
This procedure usually lasts 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 insertion process.
The results of the lumbar puncture can usually be known 48 hours after the procedure.
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. The patient may move as long as the head is not lifted from the bed. Usually the patient has to use a bedpan if he wants to urinate.
The bandage used to cover the injection hole should not be removed for 24 hours after the procedure. Patients will be allowed to go home on the same day after their body condition improves or can be treated if there is a disease condition that makes it impossible to return home, for example suspected of suffering from inflammation of the brain.
Patients were asked to avoid strenuous activity for 24 hours after the lumbar puncture was performed. The patient can return to work immediately if the job does not require him to move too much.
Patients should drink more water to reduce the risk of headaches. To help relieve headaches, patients are advised to drink beverages containing caffeine, such as tea, coffee, or soda.
Patients can also take pain relievers containing paracetamol to reduce pain in the head and back. The drug must be used in accordance with the instructions for use.
Complications and Side Effects of Lumbar Puncture (LP)
In general, a lumbar puncture is safe to perform. However, this procedure can also cause complications which include:
- Discomfort or pain in the back
- Bleeding at the injection site
- Skin infections
- Difficult to urinate
- Numbness or tingling in the legs
Dangerous and fatal side effects, such as rupture of blood vessels and displacement of the brainstem, can also occur. However, these complications are very rare.