A+Acute Medical TakeUK Acute Medicine Clinical Guide
Clinical evidenceNICE · Specialist guidance · UpToDate
Current languageEnglish
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STAND-ALONE BEDSIDE PROCEDURE PATHWAY

Lumbar puncture

Sterile CSF sampling with opening pressure and correctly prioritised tubes
Adult lumbar puncture positioning, landmarking, sterile preparation, spinal needle and pressure measurement, and sequential CSF tubes
1Position2Landmark3Sterile prep4Needle + pressure5CSF tubes

Indications

  • Suspected CNS infection/inflammation after time-critical treatment
  • Subarachnoid haemorrhage when the pathway requires CSF
  • Pressure disorders, malignancy and specialist neurological diagnosis

Stop / escalate

  • Mass lesion/obstructive hydrocephalus or clinical herniation risk
  • Infection at puncture site, major uncorrected bleeding risk or unsafe anticoagulation
  • Cardiorespiratory instability—stabilise first; do not delay antibiotics/aciclovir

Illustrated step sequence

1Consent, neurological exam, platelets/coagulation/antithrombotics and imaging decision
2Lateral decubitus for valid opening pressure; identify L3/4 or L4/5 below the cord
3Full asepsis, local anaesthetic and atraumatic spinal needle where possible
4Measure pressure with legs relaxed; collect sequential labelled tubes without aspiration
5Document level, needle, attempts, pressure, appearance, tests and complications

Samples / technical essentials

  • Cells/differential, protein and glucose with paired serum glucose
  • Gram stain/culture and syndrome-specific PCR
  • Xanthochromia, oligoclonal bands with paired serum, cytology/flow or TB/fungal tests only when indicated

Aftercare and complications

  • Observe neurology, puncture site and clinical stability
  • Post-dural puncture headache: analgesia/hydration advice; anaesthetic review for persistent severe orthostatic headache
  • Urgent assessment for new deficit, sphincter disturbance, severe back/radicular pain, fever or bleeding

Supervised clinician education. Use the current local checklist, competency standard, consent policy, infection-control procedure and escalation route. This pathway does not certify procedural competence.

Other bedside procedures

Abdominal paracentesis→Blood cultures→Chest-drain insertion→Venepuncture→Arterial blood gas sampling→