![]() ![]() Place bandage over needle insertion site.Note that in cases of doing a lumbar puncture for raised ICP it may be necessary to take a closing pressure as well as an opening pressure.There is no need to replace the stylet to do this.Once all samples are taken withdraw needle.If getting cytology up to 20ml is required (the more CSF, the higher the sensitivity).Make sure bottles are in the correctly numbered sequence.Once pressure read, collect samples by placing sterile containers under the 3-way tap and turning it to let the CSF directly out.A normal opening pressure is 12-20 cmCSF.Once the CSF has stopped advancing (leaving a swinging menincus) remember this CSF pressure. Turn the 3-way tap upwards to allow CSF fluid to fill the manometer.With flow of CSF, attach manometer & 3-way tap to the needle.If obstructed, or if needle meets resistance, withdraw the needle with stylet in place, recheck position & re-attempt the procedure.If no flow, replace stylet, rotate spinal needle a few millimetres & then recheck.Remove stylet and check for flow of spinal fluid.Advance slowly through spinous ligament resistance until you feel some give (sometimes described as a “pop”) with change in resistance as needle enters subarachnoid space. ![]()
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