Safety of lumbar puncture for adults with acute leukemia and restrictive prophylactic platelet transfusion. ↑ Vavricka SR, Walter RB, Irani S, Halter J, Schanz U.Safety of lumbar puncture for children with acute lymphoblastic leukemia and thrombocytopenia. ↑ Howard SC, Gajjar A, Ribeiro RC, et al.Management of pediatric patients with pseudotumor cerebri. ↑ Chern JJ, Tubbs RS, Gordon AS, Donnithorne KJ, Oakes WJ.CSF protein biomarkers for proximal axonal damage improve prognostic accuracy in the acute phase of Guillain-Barré syndrome. ↑ Petzold A, Brettschneider J, Jin K, et al.Timing of lumbar puncture in suspected subarachnoid haemorrhage. How Do I Perform a Lumbar Puncture and Analyze the Results to Diagnose Bacterial Meningitis? CSF WBC and neutrophils are not affected 12 hrs after antibiotics: CSF glucose levels increase and protein levels decrease.CSF cultures are negative 2 hrs after parenteral antibiotics in meningococcal meningitis, and 6 hrs in pneumococcal meningitis.For each 1000 RBC decrease protein value by 1mg/dl.WBC counted/resulted - "WBCs added" = actual WBC.Complex version (WBC and/or RBC not within normal limits):.Subtract 1 WBC for every 750 RBC in CSF.Simplified version (if peripheral WBC and RBC counts are within normal limits):.^^^For unexplained elevations of protein, consider encephalitis, MS, Guillian Barre.^^Lymph predominance may be found in patients with early bacterial meningitis or those that have been partially treated (e.g.with oral antibiotics) bacterial menintigis, and those with tuberculosis meningitis ^Normal or lower WBC results may be found in immunocompromised, early, or partially treated (e.g.Tube 3 or 4 can be used for special tests or additional cultures.Tube 4: Second cell count and differential (if indicated) or hold tube.Tube 3: Glucose, protein, protein electrophoresis (if indicated).Tube 2: Gram stain, bacterial and viral cultures. ![]() Opening pressure should be measured with patient on side with legs extended.Insert needle with bevel parallel to spinal canal.Anesthetize both superficial skin as well as along intended path of LP needle.Age 20ga almost doubles incidence of post-LP headache.If hemophiliac, replace factor before LP.Hemophilia, von Willebrand disease, other coagulopathies.Therapeutic relief of pseudotumor cerebri.Suspicion of certain central nervous system (CNS) diseases such as Guillain-Barré syndrome.Suspicion of subarachnoid hemorrhage (SAH).CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.Proper needle trajectory: skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space (containing internal vertebral venous plexus), dura, arachnoid, and subarachnoid space CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.Īccordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. Use of this site is subject to the Terms of Use. ![]() ©2023 by Children's Hospital of Philadelphia, all rights reserved. If you have questions about any of the clinical pathways or about the process of creating a clinical pathway please contact us.
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