Spinal Tap Medical Procedure

Generate Valuable Information About CSF

From its vital role in helping to effectively cushion the spinal cord from injuries, to removing waste products from the brain, cerebral spinal fluid (CSF) is an invaluable element of the human body. Analyzing this fluid, as retrieved from a spinal tap, can give medical professionals tremendous insight that can help them to diagnose such diseases as meningitis (inflammation of the meninges) or leakage of fluid from the meninges. Besides evaluating this fluid for white blood cells, glucose, and protein, the pressure of the cerebral spinal fluid itself can also be measured and it can reveal the presence of aforementioned diseases like meningitis, as well as, tuberculosis, multiple sclerosis, Guillain Barre syndrome, stroke, and spinal cord tumors. Unfortunately, there are serious medical implications involved if a spinal tap conducted reveals that the CSF pressure deviates in either direction outside of its norm.

If a patient's CSF pressure is too high, immediate medical attention may be required in order to alleviate an evident skull that is filled with high intracranial pressure (ICP). While a patient may exhibit signs and symptons of having high ICP, this may not manifest itself until a spinal tap CSF pressure reading is taken. A tumor on the spinal cord may be present if the CSF pressure is unusually low. Either way, you can see how obtaining a CSF pressure, through a spinal tap, can generate very valuable data that can help to guide a medical diagnosis, as well as, accompanying interventions to address the problem.

Step #1

Gather What You Need

As with any medical procedure, you will have everything you need in place. Items needed include:

  • a Sterile Stopcock
  • a Sterile Manometer
  • a Pair of Sterile Gloves
  • Protective Garment
  • Protective Eye Shield/ Eye Wear

Both the sterile stopcock and the sterile manometer are designed specifically for use during a spinal tap.

Step #2

Ensure Proper Patient Positioning

When performing a spinal tap, and during the retrieval of the CSF pressure, the patient will be lying on his or her side with their knees bent close to their chin, with head and upper spine bent forward, so as to provide maximum exposure of the area in which the needle with be placed. This position is otherwise called the relaxed fetal or lateral decubitus position. Rather than being placed on his or her side, this same position can be achieved from a sitting position, as well. The medical professional conducting the spinal tap will typically choose the position in which they prefer the patient to be placed in. This position must be assumed before a spinal tap in performed, and a subsequent CSF pressure reading is obtained.

Step #3

Establish CSF Flow

With the spinal (or lumbar) tap needle in place, and the patient in the proper position, you will now establish flow of the cerebral spinal fluid through the spinal tap needle. The sterile, closed, stopcock will be immediately placed onto the spinal tap needle so as to ensure that a false low (inaccurate) CSF pressure reading isn't received as a result of too much fluid leakage. Once again, this connection needs to be made as quickly and expeditiously as possible.

Step #4

Connect Manometer to the Stopcock

The sterile manometer is specifically engineered for accurate use during a spinal tap CSF pressure reading. With sterile stopcock in hand, you will now connect the manometer. At this time, the stopcock will still be in a closed position with the spinal tap needle in level with the zero mark of the manometer pressure scale.

Step #5

Turn Stopcock from Closed to Open

Now that the pressure manometer is successfully attached to the sterile stopcock, you will now turn the stopcock from the closed to the open position. When you do this, the patient's cerebral spinal fluid will begin to flow into the manometer. The fluid should be allowed to reach a stable level on the manometer pressure scale. The opening pressure will be important to note on the  patient's chart. Because of the patient's pulse and respirations (breathing), slight fluctuations in the pressure reading will be present.

Step #6

Compare CSF Pressure to Various Normals

Dependent on your patient, there are different normal values of opening cerebral spinal fluid pressure that exist. While a newborn baby will have a very low CSF opening pressure around 50mmH2O, an extremely obese patient's reading will be around 250mmH2O. As you can see, a patient's "normal" opening CSF pressure value reading will be different dependent on who your patient is. Of course, this will be and should be known well before the spinal tap needle ever even penetrates the patient's skin. With these normal values in mind, you can now compare your patient's opening CSF pressure reading to these.

Is their opening CSF pressure reading high? If so, as mentioned earlier in this InfoBarrel article, a patient's intracranial pressure inside their skull may be abnormally high.

Is their opening CSF pressure reading low? If so, as mentioned earlier, this may indicate the presence of a tumor on the spinal patient's cord. Do be sure not to jump to conclusions, however, because a variety of conditions may exist in the presence of a low CSF pressure reading.

If your patient is a normal adult, their opening CSF pressure should be 65-200 mmH20 or 5-15 mmHg.

Step #7

Close the Stopcock

Once you have obtained your patient's opening CSF spinal tap reading, be sure to close the stopcock and disattached the pressure manometer. Actual samples of the CSF can now be taken.

Step #8

Take CSF Samples and Close

Once your manometer has been disattached, you will need to reopen your sterile stopcock in order to retrieve CSF samples. Once the samples have been taken, you can then close your patient's stopcock again.

Step #9

Reattach Manometer and Take Closing Pressure

With your patient's sterile stopcock now in the closed position following the taking of a CSF sample, you can now reattach the manometer in order to obtain a closing CSF pressure. As occured when you first attached the manometer, your manometer scale will again need to be level with the spinal tap needle. Your closing CSF pressure obtained will be compared to the previous pressures mentioned in this InfoBarrel article. After the closing CSF pressure has been read, you can now disattach both the sterile stopcock and the manometer.

Be sure to never attempt to conduct a spinal tap/lumbar puncture unless you are a skilled and trained license physician operating in a sterile hospital environment.

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