procedure

Last reviewed 01/2018

• put gloves on
• put a drape on top of the patient
• clean the area e.g. with betadine
• anaesthetise the skin and subcutaneous tissues with 1% lignocaine at the chosen site
• place the spinal needle in the interspace with the bevel uppermost and advance it towards the umbilicus keeping it parallel to the ground
• when advancing the needle consider:
• when there is an increase in resistance as you go into the tough ligamentum flavum and a marked reduction of resistance when the needle passes through. When through the ligamentum flavum, the dura is very close (1-2mm away) and the needle should be slowly advanced and the stylet withdrawn after each step
• when the dura is reached there should be a free flow of cerebrospinal fluid (CSF)
• measure the opening pressure with a manometer - if greater than 40 cm of water, remove needle immediately to avoid brain stem herniation. Normal pressure is 6-20 cm of water