Lumbar Puncture Steps on Scientific
Trainer
Dr Sanjoy Sanyal MBBS, MS (Surgery), MSc (Royal College of Surgeons of Edinburgh),
ADPHAProfessor and Course Director of Neuroscience – FCM-III Neurology
Watch video here: http://www.slideshare.net/sanyalsanjoy8/demonstrating-lumbar-puncture-steps-on-gaumard-trainer-sanjoy-sanyal
L4 Spinous Process (Sitting
Position)Palpate L4 Spinous Process with both Thumbs while feeling both Iliac Crests with Other Fingers of both Hands
L4 Spinous Process (Left
Lateral Position)
L4 Spinous Process is on the Supracristal Plane (Line joining highest points of both Iliac Crests)
Head End
Skin PrepChorohexidin
e Gluconate
with Alcohol
or Povidone-
Iodine 10%
and / or
Alcohol
(Isopropyl or
Ethanol)
Povidone-
Iodine is not
used in this
trainer
because it
will stain the
trainerHead End
Sterile
Drape
Sterile drape with an opening centered
over L3-L4 Interspinous Space is placed
over patient
Head End
Local Anesthesi
a0.5 or 1% Lignocaine is
infiltrated subcutaneously at
the LP site
Head End
Manometer Assembly
Manometer (Vertical Tube) is attached to the 3-way Stop-cock, for use after inserting the LP Needle
Head End
LP Needle
Placement
26-Gauge Tuohy LP Needle with Stylet inside is advanced through L3-4 Inter-spinous Space
Head End
Assess Placement
Periodically remove Stylet to
assess placement (CSF should
drip out)
Head End
Confirm Placement
CSF dripping out confirms Needle Placement in Lumbar Cistern Subarachnoid Space
Head End
Manometer
Attachment
Manometer Assembly (with 3-way Stop-cock) is attached to Hub of Tuohy LP Needle
Head End
ICP Measuring
Intracranial Pressure can be read off from the level of CSF on the vertical tube (in Millimeters of Water)
Head End
CSF Collection
Turn the lever of 3-way Stop-cock
to collect CSF in a Test Tube for
analysis
Head End
Needle Removal
Remove Tuohy LP Needle by applying a counter-pressure on skin with left hand, using a Gauze
Head End
Sterile Dressing
Apply a dressing over LP site using
a sterile gauze or Tincture-Benzoin
seal
Head End
Acknowledgement The Gaumard Scientific trainer is in routine use in our medical institution
Special thanks are being extended to Gaumard Scientific and its Vice President John Eggert for permission to use the pictures in this presentation.
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