![]() This line is referred to as the intercristal line or Tuffier line. A line should be drawn between the superior aspects of the iliac crests. Certain conditions such as obesity, scoliosis, and degenerative disc disease may make palpation of landmarks more difficult. Palpation of landmarks along the back of the patient is used to locate the ideal insertion point for the needle. Using these landmarks will avoid inadvertent damage to the conus medullaris, which typically terminates at L1. The ideal insertion point of the spinal needle should be either in the interspinous area between L4 and L5 or 元 and L4. To help keep the needle at the midline during insertion, the lumbar spine should be perpendicular to the table in the sitting position and parallel to the table if in the recumbent position. It may be helpful to instruct the patient to flex their back "like a cat." By doing so, the space between the spinous processes increases, allowing for easier needle insertion. The patient should be instructed to assume the fetal position, which involves the flexion of the spine. The lateral recumbent position is preferred as it will allow an accurate measurement of opening pressure, and it also reduces the risk of post-lumbar puncture headache. The positioning of the patient in either a lateral recumbent position or sitting position may be used. Informed consent should be obtained before performing the procedure. Review the indications listed for head CT before performing a lumbar puncture (LP).īefore beginning, the procedure, as well as risks and benefits, should be explained to the patient. ![]() Clinical signs of or risk factors for increased intracranial pressure, coagulopathy, or thrombocytopenia should be evaluated before performing a lumbar puncture. First, begin by assessing whether there are any contraindications to performing the procedure. As with any procedure, preparation is key to ensure safety and improve the likelihood of success.
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