Lumbar Puncture

Lumbar Puncture Procedure Note:
Date: ***
Time: ***
Indication:  ***
Resident: ***
Attending : ***

A time-out was completed verifying correct patient, procedure, site, positioning, and special equipment if applicable. The procedure was described to the patient in the presence of ***. All the indications and potential side effects of the procedure were discussed in details (including but not limited to risk of bleeding, infection, nerve injury and post LP headache). Patient was understanding, agreeable and all questions were answered.
The patient was placed in the Left lateral decubitus position in a semi-fetal position with help from the nursing staff. The area was cleansed and draped in usual sterile fashion. 1% lidocaine was used anesthetize the surrounding skin area. A 3.5-inch spinal needle was placed in the L3-L4 interspace. Clear cerebral spinal fluid was obtained and the opening pressure was noted to be ****cm. Four tubes were filled with 4 mL of CSF. These were sent for the usual tests, including 1 tube to be held for further analysis if needed.

Attending Dr *** was available for the entire procedure

Estimated Blood Loss: 1ml.

Complications: No complications during the procedure.

Patient was counseled about post-LP headache and how to minimize it. He was advised to report any persistent headache, low back pain, leg tingling, numbness or weakness.


Contraindications for Lumbar Puncture:

  • Low platelet count < 40k
  • INR = or > 1.5
  • Inherited bleeding disorders (consult hematology first)
  • Intracranial space occupying lesion with mass effect
  • Arnold Chiari malformation (herniate easily)

Preform under fluoroscopy: 

  • Hx of low back surgery
  • Large BMI > 35 and can't feel spinous process on palpation

Holding antiplatelets prior to procedure: 

  • Aspirin: doesn't need to be held
  • Plavix: switch to aspirin 5 days prior to the procedure
    • Don't hold antiplatelets in patients who had barrel metal stent < 1 month or drug eluting stent < 12 months

Holding anticoagulations

  • Warfarin: held for at least 5 days
  • NOAC: 24 hours prior to procedure
  • Heparin: 6 hours prior to procedure
  • Low molecular weight heparin: 12 hours prior to procedure
    • Bridge with LMW heparin for patients at high risk of thrombotic event.

Risk factors for post-LP headache: 

  • Patient factors: young age - history of headaches
  • Procedure factors: sitting position - large needle - cutting needle - multiple attempts
    • Post-LP rest doesn't prevent or reduce post-LP headache