Lumbar Puncture Parental Advice Leaflet Children’s Services Women & Children’s Group

This leaflet has been designed to give you important information about your condition / procedure, and to answer some common queries that you may have.

Introduction A lumbar puncture (also called a spinal tap) is a medical test that involves collecting a small sample of cerebrospinal fluid (CSF) for examination. This clear, colourless liquid helps keep the body healthy by, among other things, delivering nutrients and "cushioning" the brain and spinal cord, or central nervous system.

spinal cord, a bundle of nerve fibers that transmit messages to and from the brain. The spinal cord extends from the lower part of the brain down to the upper lumbar area. A lumbar puncture is done in the lower lumbar area, below the point where the spinal cord ends. So, with a lumbar puncture, the risk of harming the spinal cord is avoided.

Words like "puncture" and "tap" seem intimidating, but the concept of a lumbar puncture (LP) is actually similar to a blood test. The fluid sample is taken to look for signs of possible infections and other important information about a person's health. While some notice a brief pinch and a slight burning sensation, most people don't consider a lumbar puncture to be painful. Still, any procedure that involves a needle is likely to cause some anxiety for a child. In neonates & infants it is the position in which it is necessary to hold them that causes most distress. It helps to understand how this test is performed. That way you can feel confident about what is happening and help put yourself and your child at ease.

About Lumbar Puncture While its name might sound scary, a lumbar puncture is actually a common procedure that only takes about 30 minutes. A Doctor or Advanced Nurse Practitioner carefully inserts a thin hollow needle between the bones of the lower spine (below the spinal cord) to withdraw the fluid sample for testing in the pathology lab. The lumbar area is a region of the spine (backbone), which is made up of 33 ringshaped bones called vertebrae. One of the main functions of the spine is to protect the

Why Cerebrospinal Fluid Is So Important The central nervous system is made up of the brain and spinal cord; it functions as the "command center" for the body. The spinal cord sends signals to and from the brain and the brain interprets them. Cerebrospinal fluid continuously flows around the central nervous system, protecting it and keeping it nourished. Since it "bathes" the central nervous system, CSF can also pick up chemicals and impurities in the brain and spinal cord. A fluid sample can provide a lot of important information about a person's health. Analyzing it for things like white blood cell count, glucose levels, protein, and bacteria or abnormal cells can help experts identify

specific diseases in the central nervous system.

Why Does My Child Need a Lumbar Puncture? Although a lumbar puncture tests for fairly serious diseases and conditions, it is also a tool to make sure a person doesn't have a certain disease or condition. So even if your child needs a LP, this doesn't necessarily mean he or she has a particular illness. By performing a lumbar puncture and testing the CSF, experts can detect or rule out suspected diseases or conditions. The most common reason a LP is performed is to determine if a child has meningitis. Occasionally, a LP is carried out to help relieve pressure in the brain caused by conditions that make the body produce too much CSF.

Preparing for a Lumbar Puncture Once it is determined that your child needs a lumbar puncture, you'll have an opportunity to ask questions. When you feel comfortable with the information, you'll be asked to sign an informed consent form, stating that you understand the procedure and its risks and give your permission for the lumbar puncture. If your child’s LP is not required to be performed immediately local anaesthetic cream will be applied to the needle insertion site. Local anaesthetic is also sometimes injected into the subcutaneous tissue over the site; this can sometimes sting initially but soon eases and the area becomes numb. Most LP’s are performed on the children’s ward or occasionally in other parts of the hospital such as Accident and Emergency, X-ray department or operating theatre. The Doctor / Advanced Nurse Practitioner

performing the LP will know your child's medical history but might ask a few additional questions, such as whether your child is allergic to any medicines. Some parents choose to be in the room with their child during the LP while others are more comfortable stepping outside to a waiting area.

During the Procedure Usually the LP is carried out whilst the patient is awake however occasionally a general anaesthetic is sometimes recommended. If a child seems to be anxious or agitated a sedative (a type of medicine that helps your child relax) may be prescribed and administered prior to the procedure. The sedative can be given by mouth, or intravenously. How your child is positioned is the most important detail in preparing for a lumbar puncture. It is important for the patient to be positioned with the back curved out so the spaces between the vertebrae are as wide as possible. This allows the Doctor / Advanced Nurse Practitioner to locate the spaces between the lower lumbar spinal bones (where the needle will be inserted). Older children may be asked to either sit on an examination table while leaning over with their head on a pillow or lie on their side. Infants and younger children are positioned on their sides with their knees under their chin. For these children, nurses / health care assistants hold them securely in position. When your child is in the desired position, a Doctor / Advanced Nurse Practitioner will use antiseptic cleaning solution to clean the area where the needle will be inserted. Sucrose given orally maybe used in children under 3 months old in an attempt to reduce

the pain experienced by the procedure. Paracetamol may also be given.

"Tapping" the Cerebrospinal Fluid Making sure your child is in the correct position, a Doctor / Advanced Nurse Practitioner carefully inserts the spinal needle between the vertebrae. The needle is carefully passed through skin and ligaments, and then through a tough membrane called the dura mater. Once the needle reaches an area called the spinal canal, the stylet is slowly pulled out to allow the cerebrospinal fluid to flow.

Risks and Complications A lumbar puncture is considered a safe procedure with minimal risks. Most of the time there are no complications although, the complications that can occur include: 

Failure to successfully perform the procedure: This may necessitate the procedure being repeated

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Headache: After a lumbar puncture, it's recommended that a patient lie down for a few hours and drink plenty of fluids, which can help stop the onset of a headache. Babies do not need to do this. However, if your child develops a headache, paracetamol will be given to ease the pain. If a headache persists for more than 2 days, call your doctor

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Infection: In rare cases, infection can occur if bacteria are introduced into the skin when the LP is performed. This is very rare because a sterile technique is used when performing this procedure

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Bleeding: If a small blood vessel under the skin is nicked during the spinal tap, there may be some bleeding

Occasionally, a small tool called a manometer is attached to the end of the spinal needle. A manometer is basically a gauge that measures the pressure of CSF. After the sample is collected (this usually takes about 5 minutes), the needle is withdrawn and a small dressing is placed on the site. Collected samples are sent to the pathology / microbiology lab for further analysis and testing. Depending on the Doctor's / Advanced Nurse Practitioner’s recommendations, your child might have to lie down on his or her back for an hour or so after the procedure.

After the Procedure Some results from a lumbar puncture are available within 2-4 hours. However, to look for specific bacteria growing in the sample a bacterial culture is sent to the Microbiology lab and these results are usually available in 48 hours although can take up to 5 days. If it is determined there might be an infection, the medical team will start antibiotic treatment while waiting for the results of the culture.

When your child is having any kind of procedure, it is understandable to be a little uneasy. It is important to know that lumbar punctures are brief, common procedures and complications are rare. If you have any questions or concerns about the lumbar puncture procedure, please talk with your Nurse, Doctor or Advanced Nurse Practitioner.

Concerns and Queries If you have any concerns / queries about any of the services offered by the Trust, in the first instance, please speak to the person providing your care.

For Diana, Princess of Wales Hospital

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Threatening / abusive behaviour

Alternatively you can contact the Patient Advice and Liaison Service (PALS) on (01472) 875403 or at the PALS office which is situated near the main entrance.

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Verbal / physical abuse

For Scunthorpe General Hospital

The Trust reserves the right to withdraw from treating patients whom are threatening / abusive / violent and ensuring the removal of those persons from the premises.

Alternatively you can contact the Patient Advice and Liaison Service (PALS) on (01724) 290132 or at the PALS office which situated on C Floor.

All acts of criminal violence and aggression will be notified to the Police immediately.

Alternatively you can email: [email protected]

The Trust welcomes comments and suggestions from patients and visitors that could help to reduce risk.

Confidentiality Information on NHS patients is collected in a variety of ways and for a variety of reasons (e.g. providing care and treatment, managing and planning the NHS, training and educating staff, research etc.). Everyone working for the NHS has a legal duty to keep information about you confidential. Information will only ever be shared with people who have a genuine need for it (e.g. your GP or other professionals from whom you have been receiving care) or if the law requires it, for example, to notify a birth. Please be assured however that anyone who receives information from us is also under a legal duty to keep it confidential.

Zero Tolerance - Violent, Threatening and Abusive Behaviour The Trust and its staff are committed to providing high quality care to patients within the department. However, we wish to advise all patients / visitors that the following inappropriate behaviour will not be tolerated: 

Swearing

Risk Management Strategy

Perhaps you have experienced something whilst in hospital, whilst attending as an outpatient or as a visitor and you felt at risk. Please tell a member of staff on the ward or in the department you are attending / visiting.

Moving & Handling The Trust operates a Minimal Lifting Policy, which in essence means patients are only ever lifted by nursing staff in an emergency situation. Patients are always encouraged to help themselves as much as possible when mobilising, and if unable to do so, equipment may be used to assist in their safe transfer. If you have any questions regarding moving and handling of patients within the Trust, you may speak to any member of the nursing staff, the designated keyworker within the department or the Trust Moving & Handling Coordinator.

Northern Lincolnshire and Goole NHS Foundation Trust Diana Princess of Wales Hospital Scartho Road Grimsby 01472 874111 Scunthorpe General Hospital Cliff Gardens Scunthorpe 01724 282282 Goole & District Hospital Woodland Avenue Goole 01405 720720 www.nlg.nhs.uk Date of issue: December, 2013 Review Period: December, 2016 Author: Advanced Paediatric Nurse Practitioner IFP-775 © NLGFT 2013