-Chiqui Valdez-

SMCQC
NCM 1o4
• a.k.a

‍ Spinal Tap
‍ Ventricular Puncture
‍ Lumbar Puncture
‍ Cerebral spinal fluid culture
Definition:
• Cerebral spinal fluid (CSF) collection
is a test to look at the fluid that
surrounds the brain and spinal cord.
Cerebral spinal fluid acts like a
cushion, protecting the brain and
spine from injury.
• Is an insertion of a needle between
the L3-L4 or L5 and cerebrospinal
fluid is withdrawn for diagnostic and
therapeutic purposes.
 CSF (cerebrospinal fluid )

• a clear fluid produced by the choroid plexus in the

ventricles of the brain that bathes the brain and
spinal cord giving them support and buoyancy to
protect from injury. This fluid is produced in the
ventricles of the brain and circulates through the
subarachnoid space (the space between the pia
and arachnoid mater of the brain and spinal cord).
More specifically, the CSF
occupies the space
between the arachnoid
mater (the middle layer of
the brain cover, meninges)
and the pia mater (the layer
of the meninges closest to
the brain). It constitutes the
content of all intra-cerebral
(inside the brain, cerebrum)
ventricles, cisterns and
sulci (singular sulcus), as
well as the central canal of
the spinal cord.
This procedure is done…
‍ …. to measure pressures within the
cerebrospinal fluid and to collect a sample
of the fluid for further testing. CSF can be
used to diagnose certain neurologic
disorders, particularly infections (such as
meningitis) and brain or spinal cord
damage.
‍ to collect CSF for testing to detect disease conditions
•
‍ to measure CSF pressure to detect hydrocephalus

‍to deliver contrast dye to the spinal canal during diagnostic

imaging

‍ to deliver anesthetic numbing agents to the spinal cord

‍ as a treatment to relieve hydrocephalus

‍during brain surgery to control CSF pressure and relax the

brain
 Materials & Equipments
Sterile gauze
needed Spinal needle
(size 22 or 24)

Sterile gloves

Antiseptic
solution
Mask (optional)
Mid open sheet/eye
sheet/fenestrated Sterile specimen
drape containers

CSF kit/tray

Manometer to
Anesthetic measure spinal
agents fluid pressure
 Procedure:
‍ The patient must lay on his or her
side, with the knees pulled up toward
the chest, and the chin tucked
downward. Sometimes the test is
done with the person sitting up, but
bent over.

‍ After the back is cleaned, the health

care provider will inject a local
numbing medicine-anesthetic
(Bupivacaine,Lidocaine, tetracaine,
procaine, ropivacaine, levobupivicaine
and cinchocaine) into the lower spine.
‍ A spinal needle is inserted, usually into
the lower back area.
(between the L3-L4 or L5 )

‍ Once the needle is properly positioned,

spinal fluid pressure is measured, and
fluid is collected (between 5 - 20 ml of
cerebrospinal fluid in 2 to 4 tubes ).

‍ The needle is removed, the area is

cleaned, and a bandage is placed over
the needle site. The patient is often
asked to lie down (dorsal
recumbent/supine position) for a short
time after the test.
• A successful lumbar puncture requires that the
patient be relaxed, an anxious patient which is
tensed, may increase the pressure reading.

• The CSF should be clear and colorless. Pink,

blood tinged, or grossly bloody CSF may
indicate a cerebral confusion, laceration or
subarachnoid hemorrhage
 Normal Values:
• Pressure: 50 – 180 mm H20
• Appearance: clear, colorless
• CSF total protein: 15 - 45 mg/100 mL
• Gamma globulin: 3 - 12% of the total protein
• CSF glucose: 50 - 80 mg/100 mL (or
approximately 2/3 of blood sugar level)
• CSF cell count: 0 - 5 white blood cells, no red
blood cells
• Chloride: 110 - 125 mEq per liter
 Normal results
Appearance: CSF is normally clear and colorless.

Pressure: Normal CSF pressure in the lower back for an adult ranges from 50–180 millimeters (mm) water. For children,
the normal opening pressure range is 10–100 mm water.

Protein: The normal protein content of CSF in an adult's lower back (lumbar) region is 15–45 milligrams per deciliter
(mg/dL) or less. Older adults and children may have higher values (up to 70 mg/dL) that are still in the normal
range.

Glucose: The normal range for glucose content in the CSF is at least 40%–80% of the blood glucose level. The levels may
be slightly increased if the person has just eaten.

Cell counts: Normal CSF contains no red blood cells (RBCs). The white blood cell (WBC) count for adults is 0–10 WBCs per
cubic millimeter (mm3). Children may normally have a higher WBC count. No neurophils are present.
Lymphocytes or monocytes are 0–4 per mm3.

Other results: No infectious organisms (such as bacteria, fungi, or a virus) are found in the CSF sample. No tumor cells are
present.
 Abnormal results
Appearance: Blood in the CSF can result from bleeding (hemorrhage) in or around the spinal cord or brain, but it may
also be caused by tiny blood vessel poked during the spinal tap. If a brain hemorrhage has occurred, the
color of the CSF may change from red to yellow to brown over several days. Bleeding caused by the lumbar
puncture itself will show more red blood cells in the first sample collected than in later samples. Cloudy
CSF may mean an infection (such as meningitis or a brain abscess) is present.

Pressure: High CSF pressure may occur as a result of swelling (edema) or bleeding (hemorrhage) in the brain,
infection (such as meningitis), stroke, or other circulatory problems. Below-normal pressure may mean a
blocked spinal canal.
Protein: A high level of protein may be caused by bleeding in the CSF, a tumor or spread of a cancer from another
area of the body, diabetes, infection, injury, Guillain-Barré syndrome, severe hypothyroidism, or other
nerve diseases. An increase in antibodies (immunoglobulins) may be caused by inflammation in people who
have multiple sclerosis, immune system disorders, or other bacterial and viral diseases.

Glucose: Low glucose levels in the CSF are abnormal and may be caused by bacterial meningitis. Viral meningitis
does not often cause low glucose levels in the CSF. Brain hemorrhage may also cause low glucose levels
several days after bleeding begins. Higher-than-normal glucose levels are often caused by diabetes.
Cell counts: Red blood cells (RBCs) in the CSF means bleeding. High levels of white blood cells (WBCs) mean
meningitis. Tumor cells and abnormal levels of white blood cells mean cancer.
Other results: Antibodies, bacteria, or other organisms in the CSF means that an infection (such as syphilis) or disease is
present. Bacterial markers (bacterial antigens) that show up mean meningitis. Cultures or stains of the CSF
may also help show the cause of meningitis or encephalitis.
 Risks:
-----Risks of lumbar puncture include:
• Hypersensitivity (allergic) reaction to the anesthetic
• Discomfort during the test
• Headache with nausea
• Paresthesia (sensation of tingling, pricking, or numbness of a
person's skin with no apparent long-term physical effect. It is more
generally known as the feeling of "pins and needles" or of a limb
being "asleep" )
• Spinal or epidural bleeding
• Trauma to the spinal cord or spinal nerve roots
• Weakness
• Loss of sensation
• Paraplegia
• Perforation of abnormal dural arterio-venous malformations
• Infection
• Spinal cord compression
 Considerations:
• This test should not be performed on people
who have lesions that cause increased
intracranial pressure. Others who should not
have this test include patients with:
-Blood clotting problems
-Thrombocytopenia
-Risk of infection