Healthcare and Medicine Reference
In-Depth Information
Figure 22.8 Positioning for lumbar puncture.
Figure 22.6 Butterfl y method for fi xing cannula.
Change the needle before inserting into the paediatric blood
culture bottle.
Alternatively, blood can be dripped into a 2-mL syringe with the
plunger removed for blood cultures.
Lumbar puncture
The anatomical landmarks and general technique are as described
in Chapter 7. The differences in children are related to size. Older
children can be treated as adults but will need more reassurance
and topical local anaesthetic. In younger children and babies,
positioning and holding is the most important thing. Ensure that
the person assisting you is familiar with the technique.
Indications
Diagnosis of meningitis and metabolic investigation.
Figure 22.7 Splint device used for joint stabilisation.
Contraindications
Signs of raised intra-cranial pressure, focal neurological signs or
clotting disorders.
Fix securely - use the butterfl y method with tape under the
cannula fl aps (Figure 22.6).
Bandage well and use a splint to keep joints stable (Figure 22.7).
Positioning (Figure 22.8)
Place the child on an adjustable bed or cot at a comfortable
height.
Lie them on their side.
Complications
Cellulitis, thrombophlebitis.
Flex the shoulders and hips.
It is not current practice to remove cannulas based on a specifi c
Position the child with their back towards you on the edge of the
time frame - the site should be monitored for signs of infection
and removed accordingly.
surface.
Keep the back straight in the vertical plane.
Blood cultures from cannula
Procedure
In all but larger children use the needle shown in Figure 22.5.
Use a sterile green (21G) needle with a 2-mL syringe. Connecting
the syringe directly can collapse the vein.
Aspirate the blood (0.5-1 mL) from within the hub of the can-
Use aseptic technique as described in Chapters 3 and 7.
Feel for the anterior superior iliac spine with your index
nula. This method can also be used as an alternative to dripping
blood into bottles.
fi nger and palpate for the intervertebral space perpendicular
to this.
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