Lumbar Puncture
What is a lumbar puncture?
During a lumbar puncture, a physician will insert a needle into your child's lower spine. This procedure may be done to:
- Obtain cerebrospinal fluid (the fluid that circulates around the brain and spinal cord) to look for infection or cancer cells
- Administer a chemotherapy agent for patients with cancer
- Monitor and relieve cerebrospinal fluid pressure for patients with pseudotumor
How is a lumbar puncture performed?
If your child has a Broviac or PICC (central lines), it can be used for the procedure. If your child has a port, it will be accessed. If your child does not have a central line, an IV will be placed. The medical team will provide medications for sedation (“relaxing medicine”) through your child’s central line or IV. If this is stressful for your child, you can ask for a child life specialist to help them with coping and relaxation techniques.
Numbing cream is applied to your child’s back. Your child will be asked to lie on their side, with knees pulled towards their chest (like they’re doing a cannon ball), or stomach. They will need to stay as still as possible in this position, and a nurse will be there to help them. Children often do not mind once they are given relaxing medicine.
We will then inject local numbing medicine into the area around the spine to maximize your child’s comfort. This feels like a small pinch followed by a tingly and/or warm feeling that lasts about a minute. After the numbing medicine, they should have little or no feeling in that area.
Using ultrasound or live X-ray (fluoroscopy) for guidance, the doctor will insert a needle into the spinal space. Once the needle is in the correct position, fluid will be removed and sent to the laboratory and/or medicine will be injected.
Will my child be awake for the procedure?
We will use either light sedation or a local numbing medicine depending on your child's age and medical history.
What are the risks of a lumbar puncture?
The procedure is considered low-risk. However, potential complications include:
- Infection
- Bleeding
- Nerve damage
- Headache
Will my child be in any pain after the procedure?
There might be mild bruising or tenderness in the lower back for a day or two.
What should I expect after the procedure is complete?
After the procedure is complete, your child will need to lie on their back in the recovery area for one hour to minimize the chance of having a headache. They can do a relaxing activity or rest during this time. After the recovery period, your child will be able to go home or return to their hospital room.
When can my child bathe?
We will place a Band-Aid® or clear bandage and gauze over the site. Keep the area dry for 24 hours. After 24 hours, you may remove the bandage and your child may shower or take a bath as usual.
How can I help my child cope/prepare?
If your child feels nervous or scared, reassure them that the medical team will take good care of them and keep them as comfortable as possible, and that you will get through this together. If your child has questions, such as “why” they need this procedure, your child life specialist is happy to speak with you about those and other diagnosis and treatment related topics.
Each child is unique and will benefit from a different level of information. You should consider your child’s age, developmental level and coping skills. These factors will help you decide when to share and how much detail to give. Older children tend to do best with more advanced notice and information that is more detailed. Younger children do best when basic information is shared closer to the day of the procedure. Child Life specialists are available to help you and your child with preparation and coping strategies.
Coping suggestions:
- Create a calm environment. For example, use soft voices and try to have just one person speak at a time.
- Your child may listen to music or watch a video. Due to the position your child will be in, we recommend using a phone or small tablet. They may also choose to rest or fall asleep.
- Some children benefit from physical touch (holding hands and stroking their hair).
Note: Children often do not remember what happens once they are given moderate sedation. They may talk, giggle or become tearful during the procedure, but they have little or no memory afterwards.
Caregiver role:
- Check with the medical provider doing the procedure to see how you can best help your child.
- A child life specialist is often able to stay for the procedure to help with coping strategies and support.