What is the proper technique for scrubbing?
Scrub each side of each finger, between the fingers, and the back and front of the
hand for two minutes.
Proceed to scrub the arms, keeping the hand higher than the arm at all times. This
prevents bacteria-laden soap and water from contaminating the hand.
What are the indications to perform a lumbar puncture?
Suspicion of meningitis or other CNS infections, susp. SAH in a pt with negative CT.
Non-emergent -- to evaluate for syphilis, hydrocephalus, unexplained sz, and
demyelinating dz.
Identify the proper technique for gowning and gloving
1. Collect the equipment needed
2. Clean the trolley surface (wipe top to bottom)
3. Wash hands-- social handwash
4. Apply surgical mask
5. Lay the gown pack on the trolley and unwrap the outer layer to expose the
contents of the pack. Take care not to touch the contents of the pack or the sterile
inner surface. Do not lean over sterile area.
6. Standing away from sterile field, peel open glove packaging, keep inside sterile.
Tip the inner packet onto sterile field.
7. ensure correct protective attire
Identify the contraindications to performing an LP
Absolute CI-- infection in the tissue near the puncture site
Relative CI-- Increased ICP (increase possibility of brain herniation) CT should be
done prior, thrombocytopenia or coagulopathies.
Describe the process for performing a lumbar puncture
1. Identify interspaces and mark puncture site at the L4-5 interspaces in a
perpendicular line from the iliac crest. The L3-4 interspace above this level may also
be used.
2. Don hat, mask, sterile gown, and sterile gloves. Set up prepared LP tray.
3. Using sponge applicator provided in LP tray, prepare the back with Chlorhexadine
solution, beginning at the site marked for the needle puncture and working outward.
Repeat twice.
4. Drape the patient
5. Recheck the landmarks
6. Infiltrate the skin and subcutaneous tissue with preservative free 1% lidocaine
with a 22-25-gauge needle.
7. Insert the spinal needle into the midline of the interspace with bevel up. Direct
the needle on a 10-degree angle toward the umbilicus (horizontal axis).
8. Advance the needle slowly, removing the stylet every 2-3 millimeters to check for
CSF flow. If the patient complains of nerve root pain, do not advance the needle.
Withdraw 2 millimeters, remove stylet and check for CSF. If none, then replace the
Scrub each side of each finger, between the fingers, and the back and front of the
hand for two minutes.
Proceed to scrub the arms, keeping the hand higher than the arm at all times. This
prevents bacteria-laden soap and water from contaminating the hand.
What are the indications to perform a lumbar puncture?
Suspicion of meningitis or other CNS infections, susp. SAH in a pt with negative CT.
Non-emergent -- to evaluate for syphilis, hydrocephalus, unexplained sz, and
demyelinating dz.
Identify the proper technique for gowning and gloving
1. Collect the equipment needed
2. Clean the trolley surface (wipe top to bottom)
3. Wash hands-- social handwash
4. Apply surgical mask
5. Lay the gown pack on the trolley and unwrap the outer layer to expose the
contents of the pack. Take care not to touch the contents of the pack or the sterile
inner surface. Do not lean over sterile area.
6. Standing away from sterile field, peel open glove packaging, keep inside sterile.
Tip the inner packet onto sterile field.
7. ensure correct protective attire
Identify the contraindications to performing an LP
Absolute CI-- infection in the tissue near the puncture site
Relative CI-- Increased ICP (increase possibility of brain herniation) CT should be
done prior, thrombocytopenia or coagulopathies.
Describe the process for performing a lumbar puncture
1. Identify interspaces and mark puncture site at the L4-5 interspaces in a
perpendicular line from the iliac crest. The L3-4 interspace above this level may also
be used.
2. Don hat, mask, sterile gown, and sterile gloves. Set up prepared LP tray.
3. Using sponge applicator provided in LP tray, prepare the back with Chlorhexadine
solution, beginning at the site marked for the needle puncture and working outward.
Repeat twice.
4. Drape the patient
5. Recheck the landmarks
6. Infiltrate the skin and subcutaneous tissue with preservative free 1% lidocaine
with a 22-25-gauge needle.
7. Insert the spinal needle into the midline of the interspace with bevel up. Direct
the needle on a 10-degree angle toward the umbilicus (horizontal axis).
8. Advance the needle slowly, removing the stylet every 2-3 millimeters to check for
CSF flow. If the patient complains of nerve root pain, do not advance the needle.
Withdraw 2 millimeters, remove stylet and check for CSF. If none, then replace the
