Lumbar Puncture

What is Lumbar Puncture

Lumbar puncture, also called a spinal tap, is a procedure that is done to remove a small amount of the fluid that surrounds the brain and spinal cord (cerebrospinal fluid, CSF). The fluid is then examined in the lab. This procedure may be done to:

• Help diagnose various problems, such as meningitis, encephalitis, multiple sclerosis, and other infections.
• Remove fluid and relieve pressure that occurs with certain types of headaches.
• Look for bleeding within the brain and spinal cord areas (central nervous system).
• Place medicine into the spinal fluid.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines like aspirin or NSAIDs.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection at the insertion site that can spread to the bone or spinal fluid.
• Bleeding.
• Spinal headache. This is a severe headache that occurs when there is a leak of spinal fluid.
• Leakage of CSF.
• Allergic reactions to medicines or dyes.
• Damage to other structures or organs.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking. If you will be given a medicine to help you relax (sedative), these instructions may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection. If so, take the antibiotic as told by your health care provider.

General instructions

• You may have a blood sample taken.
• You may be asked to shower with a germ-killing soap.
• Ask your health care provider how your surgical site will be marked or identified.
• Plan to have someone take you home from the hospital or clinic. This is especially important if you will be given a sedative.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• You may lie down on your side with your knees bent, or you may sit with your head resting on a pillow on your lap.
  • How you are positioned depends on your age and size.
  • You will be positioned so that the spaces between the bones of the spine (vertebrae) are as wide as possible. This will make it easier to pass the needle into the spinal canal.
• The skin on your lower back (lumbar region) will be cleaned.
• You will be given an injection of medicine to numb your lower back area (local anesthetic).
• You may be given pain medicine or a sedative.
• A small needle will be inserted into your lower back until it enters the space that contains the cerebrospinal fluid. The needle will not enter the spinal cord.
• Fluid will be collected into tubes. It will be sent to a lab for examination.
• The needle will be withdrawn, and a bandage (dressing) will be placed over the area.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until any medicines you were given have worn off.
• You may need to stay lying down for a while.
• You will need to drink plenty of fluids and caffeine to help prevent a headache.
• Do not drive for 24 hours if you received a sedative.

Summary

• A lumbar puncture, also called a spinal tap, is a procedure that is done to remove a small amount of the cerebrospinal fluid, CSF. This may be done to help diagnose a wide variety of conditions.
• Before the procedure, tell your health care provider about all medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Before the procedure, ask your health care provider about changing or stopping your regular medicines. This is especially important if you are taking blood thinners.
• Your lower back will be numbed with an injection before the needle is placed into your spinal canal.
• After the procedure, you will lie down for a while and you will drink plenty of fluids.

Lumbar Puncture, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Mild discomfort or pain at the puncture site.
• A mild headache that is relieved with pain medicines.

Follow these instructions at home:

Activity

• Lie down flat or rest for as long as directed by your health care provider.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Avoid lifting anything heavier than 10 lb (4.5 kg) for at least 12 hours after the procedure.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.
• Do not drive or use heavy machinery while taking prescription pain medicine.

Puncture site care

• Remove or change your bandage (dressing) as told by your health care provider.
• Check your puncture area every day for signs of infection. Check for:
  • More pain.
  • Redness or swelling.
  • Fluid or blood leaking from the puncture site.
  • Warmth.
  • Pus or a bad smell.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Drink enough fluids to keep your urine clear or pale yellow. Your health care provider may recommend drinking caffeine to prevent a headache.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have fever or chills.
• You have nausea or vomiting.
• You have a headache that lasts for more than 2 days or does not get better with medicine.

Get help right away if:

• You develop any of the following in your legs:
  • Weakness.
  • Numbness.
  • Tingling.
• You are unable to control when you urinate or have a bowel movement (incontinence).
• You have signs of infection around your puncture site, such as:
  • More pain.
  • Redness or swelling.
  • Fluid or blood leakage.
  • Warmth.
  • Pus or a bad smell.
• You are dizzy or you feel like you might faint.
• You have a severe headache, especially when you sit or stand.

Summary

• A lumbar puncture is a procedure in which a small needle is inserted into the lower back to remove fluid that surrounds the brain and spinal cord.
• After this procedure, it is common to have a headache and pain around the needle insertion area.
• Lying flat, staying hydrated, and drinking caffeine can help prevent headaches.
• Monitor your needle insertion site for signs of infection, including warmth, fluid, or more pain.
• Get help right away if you develop leg weakness, leg numbness, incontinence, or severe headaches.