Lumbar puncture is the process of removing a sample of the fluid bathing the brain and spine.
Cerebrospinal fluid (CSF) is a clear substance protecting these vital structures. If doctors suspect cancer cells have invaded the brain, or may spread there, a lumbar puncture is done to obtain a sample of CSF for examination under a microscope.
During the Procedure
A doctor or nurse practitioner will do the lumbar puncture. They will ask your child to lie in a foetal position, head and knees tucked close to the chest. Another nurse will hold your child in position. You may be asked to help, but it is important you feel comfortable and confident about doing this
Wearing sterile gloves, the clinician will thoroughly clean the lower back with antiseptic. This feels very cold to the skin. A sterile surgical drape will be placed over the area, with a window cut out over the procedure site.
Even if the area is pre-treated with a topical anaesthetic, a local anaesthetic (usually lidocaine) will be injected into the skin and underlying tissues. If the area was not pre-treated, this injection will sting or burn for about 30 seconds, but the sensation passes as the anaesthetic takes effect.
To ensure the site is completely anesthetized, there will be a couple of minutes wait at this point.
Your child must lie very still for the remainder of the procedure. So if you are not confident about your ability to help hold her in position, ask for a nurse to do this.
A hollow needle will be inserted between two vertebrae in the lumbar spine into the subarachnoid space where cerebrospinal fluid is found. The fluid will drain through the needle into a container.
When enough fluid has been collected, the needle will be gently removed and a small plaster will be placed over the puncture site.
Awake or Under Anaesthetic
Lumbar puncture will usually be done during a routine EUA. When it is not done during EUA, your child may still be given a short acting anaesthetic or sedation during the procedure. With good child life support, even young children can complete this procedure awake.
If your child is awake during the procedure, a topical anaesthetic like EMLA will be used to numb the lumbar puncture site. Different topical anaesthetics require application at different times to ensure they take effect before the procedure. Make sure you understand the timing instructions.
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