Pediatric emergency medicine trisk 4350 4350

For more complex problems, including intraluminal mineral/precipitant
occlusion or lipid emulsion occlusion, refer to the staff caring for the catheter.

LUMBAR PUNCTURE
Indications
To obtain cerebrospinal fluid (CSF) for the diagnosis of meningitis,
meningoencephalitis, subarachnoid hemorrhage, and other neurologic syndromes.
To measure opening pressure to diagnose idiopathic intracranial hypertension.

Complications
1. Contamination of the CSF sample with blood from the epidural venous plexus
2. Local back pain—occasionally with short-lived referred limp
3. Headache (uncommon in children younger than 10 years of age)
4. Apnea/hypoventilation caused by positioning for the procedure in young
infants
5. Spinal epidural/subdural hematoma or spinal cord bleeding—especially in the
presence of bleeding diathesis
6. Infection
7. Subarachnoid epidermoid tumor formation
8. Ocular muscle palsy (transient)
9. Epidural CSF leak—ranging from asymptomatic to cauda equina syndrome
10. Brainstem herniation—in the presence of a mass effect or noncommunicating
hydrocephalus

Equipment
Commercial trays; CSF manometers; spinal needle—22 gauge; 3.75 cm (1.5 in)
for younger than 1 year old, 6.25 cm (2.5 in) for 1 year to middle childhood, and
8.75 cm (3.5 in) for older children and adolescents; povidone-iodine or
chlorhexidine antiseptic solution; topical 4% lidocaine cream.

Procedure

Lateral Decubitus Position
Restrain the patient in the lateral decubitus position. Maximally flex the spine
without compromising the upper airway. Often, in infants younger than 3 months,
the patient’s hands can be held down between the flexed knees with one of the
assistant’s hands. The other hand can flex the neck at the appropriate time.
The spinal cord ends at approximately the level of the L1 and L2 vertebral
bodies. Caudal to L2, only the filum terminale is present. The desired sites for LP