Stepwise bedside procedural guides and sterile field steps
Interactive sterile equipment verification, anatomical safety landmarks, and complication rescue protocols.
Confirm written consent, verify platelet count > 50 & INR < 1.5, confirm resuscitation equipment and assistant present.
Chlorhexidine 2% in 70% alcohol, sterile gloves/gown, fenestrated drape, 1% Lidocaine, 22G atraumatic spinal needle, manometer, 4 specimen tubes.
Palpate superior iliac crests (Tuffier line = L4 level). Enter L3-L4 or L4-L5 interspace pointing bevel cephalad. Advance slowly, feel for dural "pop".
Measure CSF opening pressure (normal 10-20 cm H2O). Collect 1 mL per tube. Reinsert stylet prior to needle withdrawal. Sterile occlusive dressing.
Landmark identification, CSF opening pressure measurement, and sterile technique
Palpate the iliac crests (Tuffier line), which intersects the L4 spinous process or L4-L5 interspace. The spinal cord terminates at L1-L2 in adults.
The Medstufise reference engines provide peer-reviewed summaries for healthcare professionals and medical trainees. Always correlate clinical calculators, algorithms, and dosing tables with bedside clinical signs, patient-specific renal/hepatic parameters, and local NHS Trust hospital protocols.
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