LP Techniques
1) Lateral Recumbent Position
Patient lies on side in a fetal position. Flex the patient's knees and torso, preventing excessive flexion of the neck. Maximally flex the spine without compromising the upper airway by having patients legs drawn towards their chest. Patients hands can be placed between their knees and held by an assistant. The assistant's other hand can flex the neck at the appropriate time.
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Keep the craniospinal and transverse planes stable.
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2) Sitting Position
Place the infant in a seated position on the edge of the examination table. Place the thighs against the abdomen and flex the trunk. The assistant will stabilize the infant by grasping the patient's right elbow and knee with their left hand and the left elbow and knee with the right hand. The older child should rest elbows on their knees while the assistant stabilizes the position.
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Keep the craniospinal and transverse planes stable.
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SELECTING AN LP TECHNIQUE
Use Lateral Recumbent Position:
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for measurement of opening pressure.
Use Sitting Position:
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patients with pulmonary disorders.
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young infants: prevents hyperflexion of the neck that can precipitate respiratory distress.
IN EITHER CASE MAINTAIN PROPER ALIGNMENT AND ADEQUATELY RESTRAIN THE PATIENT.
In the critically ill or unstable patient, pre-oxygenate at Flo2 = 1.0 at 5L/min via face mask for 3 minutes to prevent hypoxemia during procedure.