Announcements: Neuromuscular section updated with more questions.

Materials:  LP tray, chlorprep x 4 or iodine solution, extra lidocaine, gown and face mask, sterile gloves, extra container (urine cup)

 Before procedure:

  • Check Head CT in order to rule out intracranial mass lesion
  • Check INR, must be < 1.5
  • Check Platelets, must be > 100
  • obtain informed consent and perform “time-out” prior to procedure

 After procedure: document procedure via SCM procedure note afterwards, check for intact leg strength and sensation, instruct patient to lay flat and administer IV fluids

Urgent indication:

  • Suspected CNS infection (with the exception of brain abscess or a parameningeal process). Do funduscopic examination and head CT first to rule out raised ICP.
  • Suspected subarachnoid hemorrhage (SAH) in a patient with a negative CT scan

 Potential Contraindications:

  • Possible raised intracranial pressure:  rule out increased ICP by head CT
  • Thrombocytopenia: if platelet is less than 100k then give platelets prior to LP
  • Anticoagulation: if INR > 1.5, then give 4 units of FFP, once finished then proceed with LP
  • Suspected spinal epidural abscess

 Normal CSF pressure is 6-20 cm H20; obese patients may have up to 25cm H20

Bring CSF to the Specimen Drop-Off, Park Street 4th Floor, back of the chemistry lab


What to Order: NOTE that SCM will print the tube number on the label

Tube 1: Cell count

Tube 2: Protein, glucose, FTA-ABS, CSF lyme, Cryptococcus, fungal cx

Tube 3: Viral studies, bacterial culture

Tube 4: Cell count, IgG index, MBP, oligoclonal bands

Extra Tube: Cytology (use specimen cup, ideally 10 cc, at least 5 cc

   Evaluate for malignant cells in CSF

   Bring to Pathology Drop Off, EP-2 across from back elevators

Extra Tube: Flow Cytometry (use specimen cup, 5 cc)

   Evaluate for lymphoma in the CSF

   Bring to Flow Cytometry, Park Street 5th floor

Extra Tube: Gene rearrangement analysis (use specimen cup, 10 cc)

   Evaluate for lymphoma in the CSF: IgH – B cell, TCR – T cell

   High false negative rate with < 50 nucleated cells in CSF

   Bring to Molecular, EP 2-631. DO NOT bring to Molecular on Park St

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