Lumbar puncture (fluoro-guided)

Why it's done

• Suspected meningitis, bleeding around the brain, or other neurological conditions.
• Measuring CSF pressure, or removing fluid to lower it.
• Giving chemotherapy or other medicine into the CSF.
• Referred to fluoro after failed bedside attempts, obesity, scoliosis, or spine surgery.

Who's in the room

Radiologist or radiologist assistant

Places the needle under fluoro, collects the fluid, and measures pressure.

Radiographer (you)

Sets up the tray, positions the patient, runs the fluoro, and labels and sends the specimens.

Step by step

1. Before. Confirm consent, blood thinners and lab values per protocol, allergies, and whether opening pressure is needed. Set up the LP kit and numbered tubes.
2. Needle. Patient prone with a pillow under the abdomen. The radiologist numbs the skin and advances the needle under fluoro.
3. Fluid. CSF is collected into tubes 1 to 4 in order. Pressure is measured if ordered.
4. After. Bandage the site, label and send the tubes right away, and explain aftercare: rest and fluids, and report a severe headache, fever, or leg weakness.

Your job

• Specimen handling: labels on the tubes, in order, sent right away (some tests need to be run fast).
• Pulsed fluoro with last-image hold; the needle is placed mostly from saved images.

Watch out for

Images

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Quick check

1. A patient with a suspected herniated nucleus pulposus is scheduled for lumbar myelography. Into which space is the contrast medium injected?

Epidural spaceIntervertebral diskSubarachnoid spaceSubdural space

2. A patient arrives for a lumbar myelogram. At the planned puncture site, the radiographer notices a pustule with surrounding redness. What is the MOST appropriate action?

Cover the pustule with a sterile dressing and proceedNotify the radiologist before the procedure beginsPerform a second antiseptic skin prep and proceedProceed using a smaller-gauge spinal needle

3. Which task is within the radiographer's role during a fluoroscopically guided lumbar puncture for myelography?

Selecting the interspace and advancing the spinal needlePreparing the sterile tray and operating the fluoroscopy unitChoosing the volume and concentration of contrast to injectWithdrawing the needle once the contrast injection is complete

4. A spinal needle used for a lumbar puncture contains a removable stylet. What is the main purpose of the stylet?

It measures CSF pressure once the needle is placedIt delivers local anesthetic to the skin and soft tissueIt prevents a core of tissue from plugging or entering the canalIt allows contrast to be injected without removing the needle

5. The needle tip in this fluoroscopy-guided lumbar puncture lies between L3 and L4. Why is an adult lumbar puncture performed at L3-L4 or L4-L5?

The subarachnoid space ends at L3, so higher levels give a dry tapL3-L4 is the only interspace where spinous processes can be palpatedThe spinal cord usually ends near L1-L2, so lower levels avoid the cordNo nerve roots lie below L2, so the needle cannot contact them

Practice it in 3D

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