Lumbar Puncture in Adults

What is lumbar puncture?

A lumbar puncture is a procedure where a fine needle is inserted between the bones of your lower back, through to the area that surrounds your spine.

This test allows samples to be taken of the fluid that surrounds your spine. This fluid is known as Cerebrospinal Fluid (CSF).

Why do I need a lumbar puncture?

There are different reasons you may be asked to have this procedure. These can include:

• Suspected spinal or brain infection – You may have been admitted with symptoms of infection in the area that covers your brain or spinal cord (meningitis), or of the tissue of your brain (encephalitis).

Taking a sample of fluid by a lumbar puncture will help the team investigate this.

• Suspected bleeding around the brain – You may have been admitted with symptoms of possible bleeding into the space around your brain (subarachnoid haemorrhage).

A sample of fluid taken by a lumbar puncture will look for signs of this bleeding.

• Possible increased pressure in the brain or spinal cord – You may have symptoms that may mean that the fluid around your brain and spinal cord is at a higher pressure than normal (intracranial hypertension).

A lumbar puncture will allow the pressure of the fluid to be measured. If necessary, it can also let the team take off enough fluid to lower this pressure and help you.

• Possible inflammation in the brain or spinal cord – Some illnesses can cause inflammation in your brain or spinal cord. This can cause damage to these areas. Fluid taken from a lumbar puncture can help your Doctor to look for signs of inflammation.

Where will this procedure be done?

You will normally have the test done on your bed on the ward you are admitted to. Sometimes, the procedure may be done by a different Doctor (called an Anaesthetist) in an anaesthetic room in the Theatre Department.

Will any checks be done before the procedure?

You will normally have the following checks before you have a lumbar puncture:

• Pulse, blood pressure, blood oxygen level, breathing rate and temperature – These will be checked by a member of the Nursing team. These are often called your “vital signs”.

• Blood tests – You will normally have your blood count and blood clotting checked. This is to make sure there is nothing that would make you more likely to have bleeding or have any side effects during the test.

You may have other blood tests such as infection markers, kidney and liver tests. This will depend on what the medical team believe is causing your symptoms,

• X-rays or other types of scans – You will normally have had an X-ray test called a CT scan of your brain before having this test. This creates a 3D picture of your brain to try to explain what is causing your symptoms.

You may also have had a different type of scan called an MRI scan. This scan uses magnetic fields to create a different type of picture of the brain.

Will I need to sign anything before the procedure?

You will normally be asked to sign a consent form. This consent form checks that you:

• have had the test explained to you

• have had a chance to ask any questions

• understand the risks and are willing to go ahead with the procedure.

Will I need to stop or change any of my normal medicines before or after I have the procedure?

For most medicines, you can continue to take them, without any changes.

If you are taking blood thinners (also known as anticoagulants), then these are normally stopped before the test.

If there is a reason that these medicines cannot be stopped, even for a short time, your team will think about whether this procedure is right for you.

Can I have any medicine to help calm my nerves before the procedure?

For most patients, this is not usually needed. However, if you are very nervous, it may be possible to have a small dose of a short-acting sedative before the procedure.

However, during the procedure you may be asked to change position, as the team performing the test do not want you to be sleepy.

Will the lumbar puncture hurt?

You will be given a local anaesthetic injection into the skin of your lower back, the muscles and the tissues between your back bones.

You will usually feel a scratch when this is done.

After this, you should not feel any pain, but you will feel pressure or pushing as they are inserting the needle to take the sample.

If you do feel any pain, please tell the Doctor, who will give you more local anaesthetic.

Can I be put to sleep to have the lumbar puncture?

Unfortunately, you cannot be asleep during this procedure. This is because you may be asked to change positions for the procedure to be successful. The procedure is done while you are under local anaesthetic.

Who will do the lumbar puncture?

The procedure will be carried out by a trained Doctor with the correct level of experience.

We are a teaching hospital and are responsible for training Doctors in skills they need to deliver healthcare in hospital medicine. We take great pride in this.

With this in mind, the procedure may be performed by a Doctor-in-training, under the supervision of a senior Doctor. A Doctor-in-training is a qualified Doctor who is going through the training programmes to be a senior Doctor.

What happens during a lumbar puncture?

The lumbar puncture is usually done in the following steps:

• Preparation – The Doctor will introduce themselves and talk you through how the test is done. They will go through the potential risks and ask you to sign the consent form when you are ready to proceed.

They will then collect and prepare all of the equipment. You will be asked to change into a hospital gown so that your lower back can be exposed.

• Position – The procedure is normally done with you lying on your left hand side with your knees bent and drawn up towards your stomach. A pillow is normally placed between your legs.

Sometimes, the Doctor may have you sitting up and leaning over a table with your head on a pillow.

• Checking the right location – The Doctor gets the right position for the lumbar puncture by identifying the backbone space, which lies between the tops of your pelvis. They will usually press on your side to find the top of your pelvis.

• Cleaning and local anaesthetic – The Doctor will then put on a plastic apron, clean their hands with disinfectant and put on sterile gloves. They will then clean the area of your lower back with a powerful cleaning solution.

Plastic drapes will then be stuck to your lower back and hips to create a sterile area to do the procedure. Local anaesthetic is then injected into your skin and between the backbone.

• Lumbar puncture and samples – The Doctor will check that the local anaesthetic is working (this is done by making sure you cannot feel anything). Then the  lumbar puncture needle will be inserted between your backbones, until the Doctor obtains a specimen of spinal fluid.

The Doctor then may attach a small plastic device to measure the pressure in the fluid.

After this, the Doctor will normally take at least three separate containers of fluid. You may hear the Doctor counting during this part, each container needs a minimum amount of fluid and this is often measured by counting the drops of fluid as they come out.

• Ending the procedure – Once all the samples have been taken, the Doctor will remove the needle and place a small dressing over the area where the puncture has taken place. This can be removed 24 hours after your procedure.

You will then be asked to stay in bed, usually lying flat in the position that is most comfortable for you.

Can I have someone with me while the lumbar puncture is being done?

Yes. If you want a family member, friend or another member of the ward team to support you during the procedure, this is usually fine. 

If you are going to have the procedure done by an Anaesthetist in an anaesthetic room, it may not be possible. The team would discuss this with you at the time.

How long does a lumbar puncture take?

This is different for each patient.

In most patients, this can be completed in 20 to 40 minutes. It rarely takes less time than this as time is taken in preparation, cleaning and local anaesthesia.

In some patients, it can take longer, especially if the gaps between your backbones are narrow or if you have had previous surgery on your lower back.

What are the possible risks, side effects or complications of a lumbar puncture?

It is important to remember that this procedure is safe and most patients have no side effects or complications.

There are some potential risks. These include:

• Failed procedure – In some patients it is not possible to get the needle into the correct place and get the necessary samples. This can happen despite following the correct technique and doing everything correctly.

• Headache after the lumbar puncture – This is rare, but there is a chance you can have a headache after a lumbar puncture. This can start within a few hours or up to 2 days after the procedure. Headaches can last 3 – 5 days.

Very rarely, headaches can start many weeks after the lumbar puncture.

Headaches are usually manageable with simple painkillers and rest.

Very rarely, the headache is severe and can result in having to stay in hospital, or being readmitted after you have been discharged home.

• Bleeding – It is normal for a very small amount of bleeding from the insertion point of the needle. This normally settles as soon as the procedure finishes. More serious bleeding around the spinal cord, known as a spinal haematoma, is extremely rare.

• Infection – As a needle is being inserted through your skin, there is a very small chance we can introduce infection into your skin or deeper into your spinal cord.

The risk is very small as all the equipment is sterile and your skin is cleaned with sterilising solution.

• Lower back pain – After the local anaesthetic wears off, you may be aware of pain in the area that the sample was taken from. This is normally mild and can usually be managed with simple painkillers.

• Nerve damage – There is a small chance of damaging the nerves leading to your leg. You may be aware of a pain or electric shock-type sensation travelling down one of your legs.

If this happens, please tell the Doctor. This sensation usually gets better after the test is finished.

Extremely rarely, some patients can have permanent damage to the nerve leading to pain, loss of sensation or loss of function.

• Cerebral herniation – This is an extremely rare but potentially severe or life threatening complication.

If there is raised pressure inside your skull, a lumbar puncture can cause this pressure to be released through the opening at the bottom of your skull where the spinal cord enters the brain. This can push part of your brain through this area. This is called cerebral herniation.

This is extremely rare and the team will examine you to make sure there are no signs of raised pressure inside your head. The CT scan of your brain will also help check for this.

• Epidermoid tumour – This is an extremely rare tumour or cancer, which develops at the site of the lumbar puncture many years after the test.

What happens if my procedure fails?

If you have a failed procedure, either the team will get another senior Doctor to try the procedure on the ward, or they will ask the Anaesthetic Doctors to perform the procedure in the Anaesthetic Department.

Are there any alternatives to having this procedure?

That will depend on why the lumbar puncture is being used. There may be alternatives if you do not wish to have this procedure. However, this may the only test that will help to determine what is causing your symptoms.

What happens after the test?

After the test, you will have your vital signs checked. You will also be asked to remain in bed, lying flat with one or two pillows for 2 to 4 hours. This reduces the chance of you having a headache after the lumbar puncture.

You are also advised to:

• Drink plenty of fluids. This will cut down the chance of a headache

• Not drive or operate heavy machinery for at least 24 hours after the procedure.

• Not take part in strenuous sport or activities for at least a week after the lumbar puncture.

When will I get the results of the lumbar puncture?

Different results are available at different times

• Immediately at your bedside – If the team believe that you had raised pressure in your spinal/brain fluid, the Doctor will measure the pressure during the test. The Doctor will be able to tell you this result right away.

They will also be able to tell you if the fluid looks normal or if there are any signs of blood or pus.

• Within 24 hours – The laboratory will usually be able to tell the sugar and protein level and if there are any signs of blood or infection within the fluid.

• 48 hours or longer – The laboratory will usually be able to tell within 48 to 72 hours if there are any abnormal cells in the fluid or any bacteria growing.

Some more specialised tests may take longer than this to perform. Your team will let you know if this is the case.

Will I be able to go home the same day I have the lumbar puncture?

This will depend on what the lumbar puncture is being performed to look for.

If you were having this procedure to look for any signs of bleeding around your brain and it was normal, and you were well, you could get to go home on the same day.

It may take longer for the results to come back if your procedure was looking for other conditions, such as infection.

Is there anything I should avoid doing after my procedure?

You must not drive or operate machinery for 24 hours after your procedure.

You must not take part in sport or any strenuous activities for a week after your procedure.

What should I look out for after I get home?

Most patients recover after their lumbar puncture without any problems.

You should seek medical help immediately, either by contacting the out of hours medical service or by going to the Emergency Department if any of the following happen:

• Double or blurred vision

• Loss of consciousness

• Drowsiness

• Weakness, numbness or tingling of your arms legs or face

• Bleeding or swelling from the area of the lumbar puncture

• Vomiting

• High temperature or fever

• Strong dislike or inability to tolerate bright lights.

Contact numbers

Emergency Department

24 hours a day, 7 days a week.

Telephone: 01642 382899

Comments, concerns, compliments or complaints

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