Despite many people's fears, there is almost no chance of spinal cord damage or paralysis because the needle is inserted in the cauda equina well below where your spinal cord ends. Women who are pregnant or think they could be pregnant should talk to their healthcare providers before having a spinal tap, especially if one with fluoroscopy is planned. Special precautions may be taken or a different kind of test may be done instead. Once you've had a physical exam and medical history, if your situation isn't an emergency, your healthcare provider will likely order blood tests before your lumbar puncture to make sure that your blood clots the way it should and that your kidneys are functioning well.
Be sure to tell your healthcare provider if you're allergic to any medications, especially local or general anesthesia. A lumbar puncture normally takes around 45 minutes to an hour, but often you're asked to lie down for another hour or two afterward.
The procedure can be done on an outpatient basis at a hospital or clinic. If you're already in the hospital or emergency room, it may be performed at your bedside. You'll be given a gown to wear for this procedure and you'll be asked to take off any jewelry, piercings, or accessories that could interfere with the test. Your healthcare provider will talk to you about food, drink, and medication restrictions before the procedure. For example, if you will need to have general anesthesia, you will likely need to refrain from eating or drinking anything for several hours or more before the spinal tap besides a very small amount of water to take your medications.
However, in an emergency situation or if you will only need to have numbing medication placed in the skin around your back, these restrictions won't apply. If you take blood-thinners like warfarin, clopidogrel, or heparin or nonsteroidal anti-inflammatory drugs NSAIDs like aspirin, ibuprofen, or naproxen, you may need to stop these several days beforehand to reduce the risk of bleeding.
Let your healthcare provider know about any other medications, supplements, or herbal remedies you're taking too. If you have health insurance, this test should be covered, but you may want to check with your insurance provider or agent to make sure, as well as to find out if you need preauthorization before you have the test.
You can also find out about any co-pay or co-insurance for which you may be responsible. If you don't have health insurance, consider calling around your area. Prices can vary greatly from facility to facility, but make sure you ask what the cost covers. In some cases, the price may reflect just the spinal tap alone without any diagnostic or healthcare provider's fees.
Also, ask about discounts for paying right away or any income-based discounts. Since you will likely be lying down for an hour or two after your procedure, you may want to bring along a book or something else to do. Bring your insurance card as well. You will need someone to drive you home after the procedure, so be sure to bring along a friend or family member, or organize to have a service pick you up when you're done. A healthcare provider, physician assistant, or nurse practitioner will perform your lumbar puncture and there may be an assistant there as well.
If you have fluoroscopy or ultrasound, there may also be a radiologist or sonographer present. You may need to fill out a consent form before you have this procedure.
You'll need to change out of your clothes into a gown and then lie on your side on a table or your hospital bed in a fetal position with your knees tucked up toward your chest. Alternatively, you may be asked to sit on the edge of the table or bed and bend forward, leaning on something stable with your back to the healthcare provider.
These positions widen the area between your lumbar bones vertebrae , allowing for easier access. If your child is the one having the lumbar puncture, he or she may have intravenous IV sedation at this time, but most kids do just fine with the local anesthetic that's typically used.
The spinal tap itself usually takes about 45 minutes to an hour, plus recovery time. Your lower back will be cleaned with a sterilizing agent such as iodine and a local anesthetic, usually lidocaine, will be injected into your skin to numb the area.
The injection of the numbing medication can cause a sharp poke and slight burning sensation. Once your back is numb, the neurologist will insert a thin, hollow needle between two of your vertebrae into the thecal sac. You will need to hold very still for this. Sometimes the needle has to be repositioned to find the right spot. You may feel pressure or a twinge of pain or numbness down your leg when the needle is inserted. For infants and young children, an ultrasound machine may be used to help guide the healthcare provider in placing the needle.
A technician may help hold your child still as well, especially if he or she hasn't been sedated. The discomfort level can vary from one person to the next. If you are obese or have degenerative bone disease, your medical team may opt to use fluoroscopy to lower the risk of a misplaced needle and avoidable pain.
Once the needle is in place, what happens depends on why you're having the lumbar puncture. The neurologist may measure the pressure of your CSF using a gauge called a manometer.
The neurologist may measure the pressure of your CSF again after the fluid has been collected. Medication like antibiotics, chemotherapy, anesthesia, or dye may be injected if you're having the lumbar puncture for this purpose. If not, or once the substance is injected, the needle is removed and a bandage is placed over the site.
You may be asked to lie down flat for an hour or two after this procedure. You'll also be given fluids to help prevent dehydration.
Both of these steps can help decrease your chance of developing a headache from the lumbar puncture. When you're discharged, you'll be able to go back to your hospital room if you're hospitalized or home with your driver. You'll need to take it easy for the rest of the day, but if you don't have a physically active job, you may be able to go back to work as long as you feel up to it. Be sure to ask your healthcare provider ahead of time about this.
Keep drinking water to make sure you stay hydrated. Your healthcare provider may give you more specific instructions. You may notice some back pain, numbness, or soreness that can feel like it's radiating down your legs after the procedure for a few days. If it's bothersome, try over-the-counter pain relievers such as Tylenol acetaminophen to help relieve the discomfort. Headaches can begin a few hours up to two days after your spinal tap. They're often minor, but sometimes they're accompanied by nausea, vomiting, dizziness, and a stiff neck.
If you experience a headache after a spinal tap, Tylenol acetaminophen can often help. Caffeine can also relieve pain and help promote CSF production. On the day of the exam you can eat a regular breakfast. Before the test, you will be asked to change into a hospital gown and an intravenous IV line will be placed in your arm.
The doctor or nurse will discuss the test with you, explain the risks, answer any questions, and have you sign consent forms. You may receive a mild sedative, intravenous fluids, or additional medication before the procedure.
Step 1: prepare the patient You may be given a sedative to make you drowsy and relaxed. A doctor and at least one assistant will be in the room. You will lie on your side with your knees drawn to your chest so that your spine is curved; in some cases you may sit on the table and lean forward onto some pillows instead. After cleaning your back with a cooling antiseptic, the doctor will numb the area of your lower back where the needle will be inserted. This may cause some brief stinging.
Step 2: insert the needle Next, a hollow needle is inserted between the third and fourth lumbar vertebrae into your spinal canal Fig. The needle doesn't touch the nerves of your spinal cord. Your doctor will collect between 5 to 20 ml of cerebrospinal fluid in 2 to 4 tubes.
You will probably feel pressure when the needle is inserted, and some people feel a sharp stinging sensation when the needle goes through the protective dural layer that surrounds the spinal cord. Although you may feel some discomfort, it is important that you lie still. Let your doctor know if you are feeling pain. Step 3: measure CSF pressure optional You will be asked to straighten your legs to decrease abdominal pressure and increase cerebrospinal fluid pressure.
The needle is attached to a meter and the pressure in your spinal canal is measured. Step 4: insert a lumbar drain optional In cases of hydrocephalus, a catheter may be inserted to continuously remove CSF and relieve pressure on the brain.
The doctor will apply pressure to the puncture site, then apply a bandage. This exam typically uses a radiographic table, one or two x-ray tubes, and a video monitor. Fluoroscopy converts x-rays into video images. Doctors use it to watch and guide procedures. The x-ray machine and a detector suspended over the exam table produce the video. This procedure may use other equipment, including an intravenous line IV , ultrasound machine and devices that monitor your heart beat and blood pressure.
X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. The technologist carefully aims the x-ray beam at the area of interest. The machine produces a small burst of radiation that passes through your body. The radiation records an image on photographic film or a special detector. Different parts of the body absorb the x-rays in varying degrees.
Dense bone absorbs much of the radiation while soft tissue muscle, fat, and organs allow more of the x-rays to pass through them. As a result, bones appear white on the x-ray, soft tissue shows up in shades of gray, and air appears black. Most x-ray images are electronically stored digital files. Your doctor can easily access these stored images to diagnose and manage your condition. Fluoroscopy uses a continuous or pulsed x-ray beam to create a sequence of images that are projected onto a fluorescent screen, or television-like monitor.
Still images are also captured and stored either on film or electronically on a computer. A nurse or technologist will insert an intravenous IV line into a vein in your hand or arm to administer a sedative. This procedure may use moderate sedation. It does not require a breathing tube.
However, some patients may require general anesthesia. The doctor or nurse may connect you to monitors that track your heart rate, blood pressure, oxygen level, and pulse. The nurse will sterilize the area of your body where the catheter is to be inserted. They will sterilize and cover this area with a surgical drape.
Your doctor will numb the area with a local anesthetic. This may briefly burn or sting before the area becomes numb. Guided by real-time x-ray images fluoroscopy , the physician will insert the needle through the skin between two lumbar vertebrae and into the spinal canal. Once the needle is in place, you may be asked to change your position slightly while fluid pressure in the spinal canal is measured.
The doctor applies pressure to prevent any bleeding and covers the opening in the skin with a bandage. No sutures are necessary. You will feel a slight pinch when the nurse inserts the needle into your vein for the IV line and when they inject the local anesthetic.
Most of the sensation is at the skin incision site. The doctor will numb this area using local anesthetic. You may feel pressure when the doctor inserts the catheter into the vein or artery.
However, you will not feel serious discomfort. You will be asked to remain very still during the procedure. A nurse or technician may help children stay still by holding them in place during the procedure.
Children may also receive a sedative to help them stay comfortable and still. Some patients develop a headache after a lumbar puncture that begins several hours or up to two days after the procedure. The headache may be accompanied by nausea, vomiting and dizziness and can last from a few hours to a week or more. You also may feel pain and tenderness in your lower back, which may radiate down your legs. If your pain continues or becomes severe, contact your doctor immediately.
A pain-relieving medication such as acetaminophen can help reduce headache or back pain following the procedure. If your headache is severe, you should contact your doctor.
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