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    Lumbal Pungsi

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    Rk N
    This document provides information on lumbar puncture (LP), including indications, contraindications, equipment, and procedures. It describes how LPs can be used diagnostically to detect conditions like meningitis, encephalitis, multiple sclerosis, and cancers. Therapeutically, LPs can be used for analgesia, anesthesia, and administering antibiotics or chemotherapy. The document outlines the proper patient positioning and techniques for performing LPs, as well as potential complications.

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    Lumbal Pungsi

    Uploaded by

    Rk N
    75 views20 pages
    This document provides information on lumbar puncture (LP), including indications, contraindications, equipment, and procedures. It describes how LPs can be used diagnostically to detect conditions like meningitis, encephalitis, multiple sclerosis, and cancers. Therapeutically, LPs can be used for analgesia, anesthesia, and administering antibiotics or chemotherapy. The document outlines the proper patient positioning and techniques for performing LPs, as well as potential complications.

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    Lumbal Pungsi

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    This document provides information on lumbar puncture (LP), including indications, contraindications, equipment, and procedures. It describes how LPs can be used diagnostically to detect conditions like meningitis, encephalitis, multiple sclerosis, and cancers. Therapeutically, LPs can be used for analgesia, anesthesia, and administering antibiotics or chemotherapy. The document outlines the proper patient positioning and techniques for performing LPs, as well as potential complications.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    75 views20 pages

    Lumbal Pungsi

    Uploaded by

    Rk N
    This document provides information on lumbar puncture (LP), including indications, contraindications, equipment, and procedures. It describes how LPs can be used diagnostically to detect conditions like meningitis, encephalitis, multiple sclerosis, and cancers. Therapeutically, LPs can be used for analgesia, anesthesia, and administering antibiotics or chemotherapy. The document outlines the proper patient positioning and techniques for performing LPs, as well as potential complications.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    LUMBAR

    PUNCTURE
    INDICATIONS :
    Diagnostic : Therapeutic :
    Infectious Analgesia
    Meningitis Anesthesia
    Encephalitis Antibiotics
    Inflammatory Antineoplastics
    Multiple Sclerosis
    Gullain-Barre syndrome
    Oncologic
    Metabolic
    Spontaneous subarachnoid
    hemorrhage
    CONTRAINDICATIONS :
    Increased intracranial pressure
    Cerebral herniation
    Impending herniation
    Possible increased ICP and focal neuro signs
    Coagulopathy
    Prior lumbar surgery
    Severe vertebral osteoarthritis or degenerative disc
    disease
    Significant cardiorespiratory compromise
    Infection near the puncture site
    Space occupying lesion
    EQUIPMENT :
    Spinal needle
    Less than 1 yr: 1.5in
    1yr to middle childhood: 2.5in
    Older children and adults: 3.5in
    Three-way stopcock
    Manometer
    4 specimen tubes
    Local anesthesia
    Drapes
    Betadine
    PROCEDURE :
    Performed with the patient
    in the lateral recumbent
    position.
    Aline connecting the
    posterior superior iliac
    crest will intersect the
    midline at approx. the L4
    spinous process.
    Spinal needles entering the
    subarachnoid space at this
    point are well below the
    termination of the spinal
    cord.
    LP in older children may be
    performed from L2 to L3
    interspace to the L5 to S1
    interspace.
    At birth, the cord ends at the
    level of L3.
    LP in infant may be performed
    at the L4 to L5 or L5 to S1
    interspace.
    Position the patient:
    Generally performed in the
    lateral decubitus position.
    Apillow is placed under the
    head to keep it in the same
    plane as the spine.
    Shoulders and hips are
    positioned. perpendicular with
    the table.
    Lower back should be arched
    toward practitioner.
    a. Ligament flavum is a strong,
    elastic, yellow membrane
    covering the interlaminar space
    between the vertebrae.
    b. Interspinal ligaments join the
    inferior and superior borders
    of adjacent spinous processes.
    c. Supraspinal ligament connects
    the spinous processes
    Atopical anesthetic (e.g. EMLAcream) can be applied 30 to 60
    minutes before performing the puncture to minimize pain on
    penetration.
    Either a sitting or lateral decubitus position can be used .
    Monitor the patient visually and with pulse oximetry for any signs
    of respiratory difficulty as a result of assumedposition.
    The subarachnoid space must be entered below the level of spinal
    cord termination.
    The spine should be flexed maximally to increase spacing between
    spinous processes.
    Extensive neck flexion, however, should be avoided to minimize a
    chance of respiratory compromise.
    Make sure the hips and shoulders are aligned &are perpendicular
    to the bed surface.
    The patient’s back should be carefully prepared and draped
    using provided disinfecting solution and drapes.
    Orient yourself anatomically and find the L4 spinous process
    at the level of iliac crests
    Palpate a suitable interspace distal to this level.
    Infiltrate 2% Lidocaine subcutaneously (without epinephrine
    to prevent cord infarction should it be introduced into the
    cord by accident) with a fine needle.
    Afield block can be applied injecting into and on either side
    of the interspinous ligaments.
    Identify the two spinal processes in between which the
    needle will be introduced, penetrate the skin and slowly
    advance the tip of the needle at about 10 degrees cephalad
    (i.e. toward the patient’s umbilicus).
    Remove the stylet and check for clear fluid will flow from
    the needle when the subarachnoid space has been penetrated.
    The ligaments offer resistance to the needle, and a “pop” is
    often felt as they arepenetrated.
    Withdraw the needle leaving the tip in, recheck the
    landmarks and slowly progress the needle again.
    Measure the opening pressure using the manometer by
    attaching it via a stopcock to the spinal needle.
    Normal opening pressure ranges from 10 to 100 mm H2O in
    young children and 60 to 200 mm H2O after eight years of
    age
    CSF volume of 1cc obtained in 3 tubes.
    In the neonate, 2ml in total can be safely removed.
    In an older child 3 to 6 ml can be sampled depending
    on the child’s size.
    Tube 1 is used for determining protein and glucose
    Tube 2 is used for microbiologic and cytologic studies
    Tube 3 is for cell counts and serologic tests for syphilis
    COMPLICATIONS :

    Herniation
    Cardiorespiratory compromise
    Pain
    Headache (36.5%)
    Bleeding
    Infection
    Subarachnoid epidermal cyst
    CSF leakage
    TERIMA KASIH
    SGB
    MS
    MIELITIS
    ONCOLOGI

     Doctors can also identify certain cancers,


    including leukemia, as the CSF analysis test may reveal
    increased numbers of white blood cells. Doctors also use
    the CSF analysis test to check for primary and
    metastatic cancerous tumors in the CNS.
    Alzheimer's disease

     The CSF analysis test can also diagnose Alzheimer's


    disease, by measuring levels of amyloid beta 1-42 (Aß1-
    42) and p- and t- tau proteins.

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