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Lumbar Puncture (LP or Spinal Tap)

Lumbar Puncture (LP), also known as a spinal tap, is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid for diagnostic testing. The main reason for a lumbar puncture is to help diagnose diseases of the central nervous system, including the brain and spine. Examples of these conditions include meningitis and subarachnoid hemorrhage. It may also be used therapeutically in some conditions.

What to Bring

  • Your physician order
  • Personal identification
  • Insurance card(s)
  • Medication list

How to Prepare for Your Lumbar Puncture Exam

  • Ask your physician for specific guidelines about discontinuing alcohol use, aspirin products and blood-thinning medications before the procedure.

**Some drugs should be stopped one or two days before the Lumbar Puncture. These include certain antipsychotic medications, antidepressants, blood thinners, and some other drugs. The most important type of medication that must be stopped is blood thinners (anticoagulants). If you are taking blood thinners, you should speak with your physician about alternative methods of maintaining anticoagulation while you are undergoing a Lumbar Puncture.

  • Make a list of any allergies you may have, especially to Iodine, Betadine, Novocaine or Latex. Allergic reactions to the contrast dye are rare, but can occur. Be sure to tell your physician if you have ever had an adverse reaction to any of the above. There are some alternate contrast materials that can sometimes be used in these cases, as well as other testing options.
  • Maintain your regular eating schedule. There are no dietary or fluid restrictions before the test.
  • If there is any possibility that you are pregnant, you should always inform your Radiologic Technologist.
  • If you have an on-body device (insulin pumps, insulin regulators, Neulasta, other chemo pumps, etc), you must inform your x-ray technologist. These devices cannot be in the x-ray room during your exam.
  • Leave all valuables at home.
  • You will be given a gown to wear during the procedure. You may be asked to remove jewelry, glasses and any metal objects or clothing that might interfere with the x-ray images.
  • Please make arrangements for transportation, as you will not be allowed to drive immediately after the test.
  • Drink 2 1/2 quarts of liquid the day of the Lumbar Puncture and the day after. This could help with eliminating a headache after the procedure.

What to Expect

  • A Radiology Nurse will call you a few days prior to your appointment to explain the process of the LP procedure. Make sure to inform the nurse of any and all medications that you are taking, especially blood-thinning medications.
  • The LP procedure is done in the Radiology Dept by a Radiologist and Radiologic Technologist.
  • The Radiologist will explain the procedure and go over the consent with you. You will be required to read and sign a PATIENT CONSENT TO MEDICAL TREATMENT for the Lumbar Puncture procedure.
  • The entire process/procedure is usually completed within 60–90 minutes.
  • Once the procedure is complete, you will be transported by stretcher to the Same Day Surgery unit for about 4 hours post-procedure to be monitor by a Same Day Surgery Nurse and instructed to lie flat (head elevate no more than 30-45 degrees).

What will I experience during and after the procedure?

  • As the patient lies face-down on the examination table, the Radiologist will use fluoroscopic guidance, to visualize the spine and determine the best placement of the needle.
  • You will lie on your stomach for the procedure. In rare circumstances, you may need to lie partially on your stomach/side.
  • At the site of the injection, your back has been cleaned with an antiseptic, and sterile cloths (called drapes) will be placed around the area.
  • A local anesthetic (pain-relieving medication) will be injected into the area on your back. You will feel a brief sting when local anesthetic is injected under the skin and you will feel slight pressure on your back as the spinal needle is inserted. Positioning the needle can occasionally cause a sharp pain.
  • When the area becomes numb, a hollow needle will be inserted in the lower back between two lumbar vertebrae. This sometimes causes a feeling of pressure.
  • The spinal canal will be penetrated and fluid will be collected. The spinal cord will not be touched by the needle during the test. You may feel some discomfort or have a minor headache.
  • Fluoroscopic imaging will be taken, so that the Radiologist can visualize the needle and contrast entering your spinal canal. This part of the procedure takes between 15-30 minutes.
  • The needle will be removed after the fluid has been removed. The area will be covered with a small bandage.
  • If ordered by your doctor, a blood sample will be taken from a vein in your arm and tested along with the spinal fluid that was collected in the lab.
  • Following the conclusion of the Lumbar Puncture, the patient will be transported by stretcher to Same Day Surgery where vital signs and general patient conditions are observed for two to four hours, resting with the head elevated at a 30- to 45-degree angle for as long as four hours.
  • You may feel tired, and your back may be sore where the needle went in (the puncture site). You may have a mild headache for a day or two. This can happen when some of the spinal fluid is removed. Some people also have trouble sleeping for a day or two.
  • If you develop a headache, lie down as much as possible and drink plenty of fluids.
  • Avoid strenuous or vigorous exercise for a day or so following the lumbar puncture. Rest when you feel tired so that you can recover well.
  • You should contact your referring physician to let them know that you have had the procedure and that you are waiting for the results. Be sure to talk to your physician about when you can resume taking your blood-thinning medications.

Although the risk of infection is extremely low, there are still some risks associated with a Lumbar Puncture include pain or discomfort at the puncture site, infection, fever, headache, unusual drainage from puncture site. Contact your referring physician if you develop a fever or continue to feel pain for more than a few days. Patients should seek emergency care if they experience any of the following symptoms after the Lumbar Puncture: Pass out (lost consciousness), new or higher fever and a stiff neck, severe headache or sore back for more than 2 days, feel numb or lose strength below the puncture site.