Lumbar Puncture (Spinal Tap)

Lumbar puncture , 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 medical provider order (Your medical provider may have already sent this to us.)
• Personal identification
• Insurance card(s)
• Medication list and dosages

How to Prepare for Your Lumbar Puncture Exam

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

Some medications 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 medical provider about alternative methods of maintaining anticoagulation while you are undergoing a lumbar puncture.

• Make a list of any allergies you might have, especially to iodine, Betadine, Novocain or latex. Allergic reactions to the contrast dye are rare but can occur. Be sure to tell your medical provider 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 you are pregnant or think you might be 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 arrange 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 following day. This could help with eliminating a headache after the procedure.

What to Expect

• A radiology nurse will call you a few days before your appointment to explain the process of the lumbar puncture procedure. Make sure to inform the nurse of all medications you are taking, especially blood-thinning medications.
• The lumbar puncture procedure is done in North Oaks’ Radiology Department by a radiologist and a 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, including the procedure, is usually completed within 60 — 90 minutes.
• Once the procedure is complete, you will be transported by stretcher to the Same Day Surgery Center for about 4 hours after the procedure to be monitored by a Same Day Surgery nurse and instructed to lie flat (i.e., your head will be elevated no more than 30-45 degrees).

Key Points to Know During and After the Exam

• You will be asked to lie on the examination table face down (on your stomach), and the radiologist will use fluoroscopic guidance to visualize the spine and determine the best placement of the needle.
• In rare circumstances, you may need to lie partially on your stomach/side.
• At the site of the injection, your back will be 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 of the 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 medical provider, 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, you 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 your head elevated at a 30- to 45-degree angle for as long as 4 hours.
• You may feel tired, and your back may be sore where the needle went in (the puncture site). You also 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 you can recover well.
• You should contact your referring medical provider to let them know that you have had the procedure and that you are waiting for the results. Be sure to talk to your medical provider about when you can resume taking your blood-thinning medications.

IMPORTANT NOTE:
Although the risk of infection is extremely low, there are still some risks associated with a lumbar puncture, including pain or discomfort at the puncture site, infection, fever, headache and unusual drainage from puncture site. Contact your referring medical provider if you develop a fever or continue to feel pain for more than a few days. Please seek emergency care if you experience any of the following symptoms after the lumbar puncture: loss of consciousness (i.e., pass out), new or higher temperature fever and a stiff neck, severe headache, sore back for more than 2 days, numbness or loss of strength below the puncture site.

TO SCHEDULE AN APPOINTMENT

Call North Oaks Scheduling between 7 am and 5:30 pm.
Hammond: (985) 230-7777
Livingston: (225) 686-4899

If you are a provider and need to send an order, please send it via fax to (985) 230-6781.