Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Introduction
- Classification of Devices
- Fixed-Performance Devices
- Variable Performance Devices
- Introduction: The 4th National Audit Project
- Anatomy
- Approaches
- Difficult Airway Society’s Recommended Technique
- Introduction: NAP4
- How to Predict an Anatomically Difficult Airway
- Equipment
- Difficult Airway Society Guidelines and Airway Management in Critically Ill Adults
- Tracheostomy difficulties
- Introduction
- Indications for Bronchoscopy in the ICU
- Contraindications
- Procedure
- Complications
- Conclusion
- Introduction
- Pre-procedural Considerations
- Procedure
- Post-procedure
- Acknowledgements
- Introduction
- Indications
- Contraindications (Relative)
- Technique for Insertion
- Drainage Bottles
- Pneumothorax Management
- Analysis of Fluid
- Complications
- Introduction
- Diagnosis of Acute Respiratory Failure
- Ultrasound in the Role of Weaning from Mechanical Ventilation
- Pleural Effusions
- Distinguishing Atelectasis from Pneumonia
- Ultrasound to Distinguish ARDS from Cardiac Pulmonary Oedema
- Introduction
- Spirometry
- Inspiratory and Expiratory Flow–Volume Loops in Upper Airway Obstruction
- Bronchodilator Response and Reversibility
- Lung Volumes
- Disease Patterns
- Gas Transfer
- Indications
- Contraindications to Line Insertion
- Risks/Complications
- Potential Insertion Sites
- Allen’s Test
- Procedure
- Introduction
- Localisation of Vasculature
- Techniques for Ultrasound-Guided Peripheral Vascular Access
- Introduction
- Indications
- Contraindications
- Complications
- Ultrasound
- Sites
- Procedure
- Confirmation of Line Placement
- Arterial Puncture
- Introduction
- Equipment Components
- Procedure
- Interpretation
- Clinical Use of Pulmonary Artery Catheters
- Complications
- Introduction
- Pad Positions
- Defibrillation
- Summary of Defibrillation Protocol in Advanced Life Support
- Optimising Defibrillation
- Oxygen
- Drugs in Defibrillation
- Energy Levels
- Implantable Cardioverter–Defibrillators
- Cardioversion outside the Cardiac Arrest Situation
- Complications
- Introduction
- Temporary
- Permanent Transvenous
- Miscellaneous
- Basic Pacing Concepts – Sensing and Capture
- Modes of Operation
- Management of Temporary Systems in the ICU
- Management of Permanent Systems in the ICU
- Pathophysiology of Cardiac Tamponade
- Aetiology of Pericardial Effusion
- Diagnosis
- Indications for Pericardiocentesis
- Contraindications of Pericardiocentesis
- Procedure
- Complications of Pericardiocentesis
- Introduction
- Pulmonary Artery Catheters
- Transoesophageal Echocardiography
- Doppler Devices
- Pulse Pressure Analysis
- Non-invasive Techniques
- Research Tools
- Introduction
- Lead placement and FICE views
- The Essence of FICE
- Common Pathologies Identified
- Acknowledgements
- Introduction
- Indications
- Contraindications
- Lumbar Punctures in the Emergency Setting
- Equipment and Technique
- Samples to Send
- Interpreting Results in Suspected Meningitis
- Complications
- Introduction
- Indications
- Anatomy, Physiology and Pharmacology
- Epidural Regimes
- Assessment and Monitoring
- Troubleshooting
- Introduction
- Indications
- Contraindications
- Technique for Insertion
- Volume Replacement
- Analysis of Fluid
- Complications
- Introduction
- Indications
- Contraindications
- Technique for Insertion
- Aftercare
- Complications
- Introduction
- Indications
- Contraindications
- Risks/Complications
- Procedure
- Additional Points
- Section 5.1 Practical Respiratory System
- Section 5.2 Practical Cardiovascular System
- Section 5.3 Practical Central Nervous System
- 5.3.1 Principles of Performing a Lumbar Puncture (Intradural/‘Spinal’)
- 5.3.2 Management and Administration of Analgesia via an Epidural Catheter
- Section 5.4 Practical Gastrointestinal System
- Section 5.5 Practical Genitourinary System
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
5.3.1 - Principles of Performing a Lumbar Puncture (Intradural/‘Spinal’)
from Section 5.3 - Practical Central Nervous System
Published online by Cambridge University Press: 27 July 2023
Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Introduction
- Classification of Devices
- Fixed-Performance Devices
- Variable Performance Devices
- Introduction: The 4th National Audit Project
- Anatomy
- Approaches
- Difficult Airway Society’s Recommended Technique
- Introduction: NAP4
- How to Predict an Anatomically Difficult Airway
- Equipment
- Difficult Airway Society Guidelines and Airway Management in Critically Ill Adults
- Tracheostomy difficulties
- Introduction
- Indications for Bronchoscopy in the ICU
- Contraindications
- Procedure
- Complications
- Conclusion
- Introduction
- Pre-procedural Considerations
- Procedure
- Post-procedure
- Acknowledgements
- Introduction
- Indications
- Contraindications (Relative)
- Technique for Insertion
- Drainage Bottles
- Pneumothorax Management
- Analysis of Fluid
- Complications
- Introduction
- Diagnosis of Acute Respiratory Failure
- Ultrasound in the Role of Weaning from Mechanical Ventilation
- Pleural Effusions
- Distinguishing Atelectasis from Pneumonia
- Ultrasound to Distinguish ARDS from Cardiac Pulmonary Oedema
- Introduction
- Spirometry
- Inspiratory and Expiratory Flow–Volume Loops in Upper Airway Obstruction
- Bronchodilator Response and Reversibility
- Lung Volumes
- Disease Patterns
- Gas Transfer
- Indications
- Contraindications to Line Insertion
- Risks/Complications
- Potential Insertion Sites
- Allen’s Test
- Procedure
- Introduction
- Localisation of Vasculature
- Techniques for Ultrasound-Guided Peripheral Vascular Access
- Introduction
- Indications
- Contraindications
- Complications
- Ultrasound
- Sites
- Procedure
- Confirmation of Line Placement
- Arterial Puncture
- Introduction
- Equipment Components
- Procedure
- Interpretation
- Clinical Use of Pulmonary Artery Catheters
- Complications
- Introduction
- Pad Positions
- Defibrillation
- Summary of Defibrillation Protocol in Advanced Life Support
- Optimising Defibrillation
- Oxygen
- Drugs in Defibrillation
- Energy Levels
- Implantable Cardioverter–Defibrillators
- Cardioversion outside the Cardiac Arrest Situation
- Complications
- Introduction
- Temporary
- Permanent Transvenous
- Miscellaneous
- Basic Pacing Concepts – Sensing and Capture
- Modes of Operation
- Management of Temporary Systems in the ICU
- Management of Permanent Systems in the ICU
- Pathophysiology of Cardiac Tamponade
- Aetiology of Pericardial Effusion
- Diagnosis
- Indications for Pericardiocentesis
- Contraindications of Pericardiocentesis
- Procedure
- Complications of Pericardiocentesis
- Introduction
- Pulmonary Artery Catheters
- Transoesophageal Echocardiography
- Doppler Devices
- Pulse Pressure Analysis
- Non-invasive Techniques
- Research Tools
- Introduction
- Lead placement and FICE views
- The Essence of FICE
- Common Pathologies Identified
- Acknowledgements
- Introduction
- Indications
- Contraindications
- Lumbar Punctures in the Emergency Setting
- Equipment and Technique
- Samples to Send
- Interpreting Results in Suspected Meningitis
- Complications
- Introduction
- Indications
- Anatomy, Physiology and Pharmacology
- Epidural Regimes
- Assessment and Monitoring
- Troubleshooting
- Introduction
- Indications
- Contraindications
- Technique for Insertion
- Volume Replacement
- Analysis of Fluid
- Complications
- Introduction
- Indications
- Contraindications
- Technique for Insertion
- Aftercare
- Complications
- Introduction
- Indications
- Contraindications
- Risks/Complications
- Procedure
- Additional Points
- Section 5.1 Practical Respiratory System
- Section 5.2 Practical Cardiovascular System
- Section 5.3 Practical Central Nervous System
- 5.3.1 Principles of Performing a Lumbar Puncture (Intradural/‘Spinal’)
- 5.3.2 Management and Administration of Analgesia via an Epidural Catheter
- Section 5.4 Practical Gastrointestinal System
- Section 5.5 Practical Genitourinary System
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
Summary
Key Learning Points
1. A lumbar puncture (LP) is a useful and extremely valuable investigation and should always be considered early.
2. LPs carry a morbidity risk, and patients should be screened for contraindications before performing the procedure.
3. Performing an LP in the sitting-up position is likely to be easier than in the lateral position; however, it does prevent all the tests from being done and may not be as well tolerated by the patient (particularly the acutely meningitic patient).
4. The risk of post-dural puncture headache can be minimised by using the smallest possible ‘non-cutting’ needle.
5. Ensure to send all samples that may be required and do not forget a paired serum glucose.
- Type
- Chapter
- Information
- Intensive Care MedicineThe Essential Guide, pp. 603 - 607Publisher: Cambridge University PressPrint publication year: 2021
References
References and Further Reading
Association of Anaesthetists of Great Britain and Ireland. Safety guideline: skin antisepsis for central neuraxial blockade. Anaesthesia 2014;69:1279–86.Google Scholar
McGill, F, Heyderman, RS, Michael, BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect 2016;72:405–38.Google Scholar
Oxford Medical Education. 2015. Lumbar puncture. www.oxfordmedicaleducation.com/clinical-skills/procedures/lumbar-puncture/Google Scholar
Perry, S, Barnes, J, Allen, A. Tips from the shop floor: performing and interpreting a lumbar puncture. Br J Hosp Med (Lond) 2018;79:C183–7.CrossRefGoogle Scholar
Plewa, M, Dulebohn, S. Postdural Puncture Headache. Treasure Island, FL: StatPearls Publishing; 2017. www.ncbi.nlm.nih.gov/books/NBK430925/Google Scholar