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.