Radiology - X-ray guided lumbar puncture

Introduction

A Lumbar Puncture (LP) is a procedure used to obtain a sample of cerebrospinal fluid (CSF). CSF is the fluid that bathes and protects the brain and spinal cord. It is produced constantly, so that the small amount removed during a LP is quickly replaced.

Why do a LP?

CSF testing can provide your doctors with information about how the brain and spinal cord is working. When this is combined with a history, examination and scan results. A LP may help diagnose a wide range of neurological conditions.

How is a LP performed?

You will usually be asked to lay on your side on a bed with your knees curled up to your stomach. Occasionally, a LP is performed with you sitting upright.

The skin of your lower back is then cleaned with an antiseptic. The antiseptic feels wet and cold. A local anaesthetic is then used to numb the skin. You may feel a stinging sensation before the local anaesthetic begins to work. You may then feel a pushing sensation as the needle is inserted, and sometimes a brief, sharp pain when the needle is moved forward. This pain should stop in a few seconds. It is important to lie still. Overall, discomfort is minimal to moderate.

Once the needle is correctly positioned, the doctor will collect samples that are sent off to the laboratory.

What are the side-effects and risks?

One of the most common side-effects is headache. This is known as a post-LP headache and is caused by the removal of CSF. This occurs in up to half of patients. Typically, the headache starts 1-2 days after the LP and symptoms are usually worse when standing up and may be eased by lying down. You may also feel sick or dizzy. These symptoms usually settle after a few days but may persist for over a week.

If you experience a post-LP headache, you should lie down and rest. You should also try to keep drinking fluid, especially drinks containing caffeine such as tea, coffee and cola. Simple painkillers such as Paracetamol may be helpful, but please ensure that you do not exceed the maximum dose stated on the packet. You should not usually need to seek medical aid. If your symptoms are not settling after 3 days contact the ward where the procedure took place (see contact details section).

Another common side-effect is backache. This is known as a post- LP backache. This occurs in up to a third of patients and is usually mild and settles over a few days. Simple painkillers are often helpful.

Very rarely, an infection may develop after a LP and this can be serious. If you develop a fever you should also contact the ward where your procedure took place. They will be able to give you advice and if required arrange an urgent appointment with one of our doctors.

Very rarely, a LP can cause damage to the nerves in the back. If you develop numbness or tingling in the legs, you should again contact the ward.

If you experience any of the following you must seek immediate medical advice:

• Increasing pain not controlled by pain killers
• Increasing swelling, redness or bleeding at the puncture site
• Feeling unwell (dizziness, fainting, temperature over 38 °C)

What happens if I decide to have a LP?

If you are not already an inpatient, you will be booked in as a day case admission onto the Surgical Admissions Lounge (SAL). You will have the opportunity to ask the specialist nurse or doctor any questions you may have before the procedure.

You will be asked to sign a consent form before the procedure is performed.

Blood and urine samples will be taken before the procedure.

The entire procedure usually takes about 30 minutes to an hour. You will be advised to lie on your back for another hour or two post-procedure. You will be monitored by a nurse throughout this time.

After that you may sit up and you will be encouraged to have plenty to drink. You are advised not to drive after the procedure and are required to have someone to take you home and stay with you overnight. You should be able to drive the next day if you feel well.

You should take things easily for a couple of days, take plenty of fluids and avoid alcohol and heavy lifting. Plenty of rest is advised to avoid headaches.

Why do I need to have my treatment under x-ray guidance?

In some patient’s lumbar punctures are sometimes required to be completed under x-ray guidance due to a variety of conditions which make it more complicated. Using x-ray guidance allows the clinician to accurately perform the procedure using images of the spine.

The doctor performing the procedure (Radiologist) specialises in using minimal amounts of x-rays. They will only use x-rays for a short time. Using the x-ray machine will make the procedure faster as the doctor can see where the needle is using the x-rays.

Advice following your LP

For emergency medical advice you should contact your GP or NHS Direct or the Ambulance Service in case of life-threatening concerns.

Post care advice following discharge from the Surgical Admissions Lounge

• Dressing must stay on for 24 hours
• You must not walk or drive home and must have an adult to take you home in a car or taxi and stay with you overnight
• You must live within 30 minutes car drive of a 24-hour Accident and Emergency Department – if this cannot be provided then an overnight stay is required.

You must seek immediate medical advice for any of the following:

• Increasing pain not controlled by pain killers
• Increasing swelling, redness or bleeding at the puncture site
• Feeling unwell (dizziness, fainting, temperature over 38 °C)

Could you be pregnant?

If there is any chance you could be pregnant, please call 0161 2065091 if your appointment is at Salford Royal Hospital or 0161 656 1178 if your appointment is at Royal Oldham Hospital.

Is x-ray guidance dangerous?

All x-ray machines use potentially harmful x-rays. Modern equipment is designed to keep the dose you receive as low as possible. If your doctor has asked for this test, they will have decided that the benefits from the procedure outweigh the risks from the very small dose of radiation that you receive.

What if I cannot attend my appointment?

If you have any queries about your appointment or cannot attend, then please telephone the booking office on 0161 204 2044 or 2404 (Salford Royal Hospital) or 0161 624 0420 (Royal Oldham Hospital) available Monday to Friday 8.30am to 4.00pm.

You can also email booking.radiology@nca.nhs.uk (Salford Royal Hospital) or bookingandscheduling.outpatients@nca.nhs.uk (Royal Oldham Hospital).

Please include name, date of birth, address and hospital number (if known) in any correspondence.

I need an ambulance. How do I arrange one?

If you need an ambulance there are contact details on your appointment letter.

Please contact us if you are arriving by ambulance so we can time your appointment with your ambulance arrival. If we are not aware that you are coming by ambulance you may miss your appointment and it may have to be rebooked.

If you need an interpreter

If you need an interpreter for your examination, please call the department so that we can try and arrange this.

Contact Details

We hope your questions have been answered by this leaflet.

If you require help or any other information regarding your appointment you can contact:
The Angiography Department, Salford Royal Hospital Tel: 0161 206 2206/5091
Interventional Radiology, Royal Oldham Hospital Tel: 0161 656 1178