EQUIPMENT
Spinal tap (lumbar puncture) tray:

Antiseptic solution
Sterile drape
3-way stopcock
Spinal fluid pressure manometer
Lumbar puncture needle (various sizes)
Fluid collection tubes (3 or 4)

Gloves, sterile (physician)
Gloves, nonsterile (nurse)
Local anesthetic
Band-Aid or 2

× 2 gauze

Adhesive bandage
Gauze sponges

GENERAL GUIDELINES FOR DIAGNOSTIC
TESTS

1. Explain procedure to child and family. Enhances cooper-

ation and participation and reduces anxiety and fear.

2. Obtain signed consent.
3. Gather equipment. Promotes organization and effi-

ciency.

4. If possible, have child void before procedure. Promotes

comfort and avoids interruption of procedure.

5. Wash hands. Reduces transmission of microorganisms.

PROCEDURE

1. Steps 1–5 of General Guidelines.
2. Place child in a knee-to-chest position, either recum-

bent or seated, with neck flexed toward knees. Provides
maximal separation of vertebral bodies and allows access
to spinal canal.
a. Recumbent position (lateral recumbent). (Figure 15)

1. Infant or young child.

a. Restrain by placing one arm under child’s

flexed knees and grasping child’s wrists.
Restrains both upper and lower extremities.

b. Place other arm posteriorly around child’s

neck and shoulders.

2. Older child.

a. Child may grasp knees with hands.
b. May place a pillow between the knees.

Prevents the upper leg from rolling forward.

c. Nurse helps hold arms and legs in flexed posi-

tion.

NOTE: It may require someone with strength to safely
restrain the child during the procedure.

b. Sitting position.

1. Older child.

a. Sit on table with elbows resting on knees and

back arched.

b. Place pillow in front of child and instruct child

to grab it.

2. Small infant. (Figure 16)

a. Hold in sitting position.
b. Flex thighs on abdomen and grab elbows and

knees with hands. Flexes spine at appropriate
angle.

43

Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.

SKILL 15

SKILL 15

Assisting with Child during Lumbar Puncture

FIGURE 15 Side-lying position for lumbar
puncture.

FIGURE 16

Sitting position for lumbar

puncture.

continued

NOTE: This position is possible only with a small
infant who is unable to struggle or with an older child
who will cooperate without restraint.

3. Once child is positioned, the physician drapes the back,

identifies and cleanses the puncture area, infiltrates the
area around the puncture site with local anesthetic, and
carries out the procedure. Strict aseptic technique is
maintained throughout.

4. See Assisting with Collection of Specimens (Skill 16).
5. During the procedure remind the child not to cough

and to breathe slowly and deeply. Coughing or changes
in breathing increase cerebrospinal fluid (CSF) pressure
giving a false reading.

6. Monitor for complications throughout the procedure;

changes in level of consciousness (LOC); pupil size and
reactivity; respiratory status; vital signs (VS); numbness,
tingling, or pain radiating down the legs.

7. After the procedure, continue to observe/monitor the

above as well as:
a. VS, LOC, and motor activity every 15 minutes for 1

hour, then every 30 minutes for 1 hour or according
to agency policy.

b. Bleeding or CSF leakage at puncture site every 4

hours for 24 hours or according to agency policy.

c. Severe headache. Leakage of CSF through puncture

hole in meninges causes the headache pain.

8. Keep child flat after procedure for 1–24 hours depend-

ing on agency policy. Reduces the risk of spinal
headache.

9. Encourage child to force fluid by mouth unless con-

traindicated. Replaces fluid lost during the procedure
and reduces chance of spinal headache.

44

Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.

SKILL 15

SKILL 15

Assisting with Child during Lumbar Puncture

continued