Procedure - LP

Question 1

What size needles are spinal needles?

Answer 1

20 or 22 gauge
- Infants: 1.5 inches
- Children: 2.5 inches
- Adults: 3.5 inches

Question 2

Always hold the needle __________________.

Answer 2

at the base

Don’t touch the needle where it will go into the skin, because this makes it less sterile.

Also, you’ll have more control if you hold the base.

Question 3

If you don’t want to use the drape, you can use _______________.

Answer 3

sterile gauze to hold the iliac crest

Question 4

Tips on positioning: ____________________.

Answer 4

• Have the patient lie as flat and straight as possible. This means the bed is flat, their shoulders aren’t rotated, and they aren’t tilted to one side or another. Check for any bending too.
• Move all of their clothing well out of the field
• Have them curl into a ball if decubitus.
• If they’re sitting upright, then have them place their feet on a chair to keep bent.

Question 5

Remove the stylet when _______________.

Answer 5

you feel the first pop

Question 6

When advancing your needle, move in _________________.

Answer 6

slow, short

Question 7

How much fluid can you remove in a large volume headache for ICH?

Answer 7

20-30 mL

40 mL and above leads to high risk of HA

Question 8

Review the features of post LP headache.

Answer 8

• Usually occurs about 48 hours after the LP
• Worse with sitting, standing, and coughing

Side note: these kinds of headaches are thought to occur because of a persistent CSF leak that puts traction on the cord.

Question 9

Review the features of post LP headache.

Answer 9

• Usually occurs about 48 hours after the LP
• Worse with sitting, standing, and coughing

Side note: these kinds of headaches are thought to occur because of a persistent CSF leak that puts traction on the cord.

Question 10

How much CSF does an average adult have?

Answer 10

150 mL

Question 11

How many different kinds of spinal needles are there?

Answer 11

Four:
- Sprotte: lumen exits via side eye and is scooped away
- Whitacre: lumen exits on side and is flat
- Quincke: standard straight bevel
- Atraucan: scooped bevel

Question 12

What two things have been shown to decrease the incidence of post-LP headache?

Answer 12

Using a spinal (non-cutting) needle

Inserting with the bevel parallel to the nerve fibers (pointing to the patients sides

Question 13

What is the normal range for CSF glucose?

Answer 13

45-85