Who performs lumbar punctures (LP)?

From the Guidelines

Lumbar punctures (LP) should be performed by physicians with specialized training, such as neurologists, neurosurgeons, anesthesiologists, emergency medicine physicians, and some internal medicine specialists, as well as advanced practice providers like physician assistants and nurse practitioners with appropriate training. When performing a lumbar puncture, it is essential to follow consensus recommendations to reduce the risk of adverse events, including evaluating potential contraindications, identifying patient-related risk factors, and using an atraumatic narrow-bore (≥22-gauge) needle 1. The choice of needle depends on the patient's age, weight, and the purpose of the procedure, aiming to minimize discomfort and the risk of complications 1. Key considerations for the procedure include:

• Using atraumatic needles, which have a consistently favorable safety profile compared to cutting-bevel needles, with a lower risk of post-LP headache 1
• Placing the patient in the lateral recumbent position and using passive rather than active withdrawal of CSF when feasible 1
• Collecting less than 30 mL of CSF and communicating effectively to allay the patient's fears and concerns 1 In some cases, radiologists may perform image-guided spinal taps for patients with difficult anatomy or previous failed attempts. The provider performing the procedure should have experience in recognizing complications such as post-procedure headache, infection, or bleeding, and provide appropriate follow-up care, including instructions to lie flat for a period after the procedure to reduce the risk of headache.

From the Research

Lumbar Puncture Performance

• Lumbar punctures (LPs) are performed by various health professionals, including neurologists, as they are an important tool in the diagnosis of neurological diseases 2.
• The procedure can be carried out by different clinicians, with neurologists performing the largest number of LPs, but only accounting for one fifth of all procedures 3.
• Optimal performance and use of LP requires individual skill and judgment, and often benefits from close liaison with several disciplines, including emergency, intensive care, diagnostic laboratory, clinical imaging, neurology and infectious/ communicable diseases specialists 4.

Performance Frequency and Settings

• A retrospective study of 6,594 cases found that 80% of LPs were performed for diagnostic purposes, with 20% of these LPs being performed in the Neurology Department 3.
• The study also found that 1.4 LPs per 100 hospital stays were performed and 0.8 LP for 100 Emergency department admissions 3.
• LPs can be performed in various clinical settings, including routine check-ups, emergency departments, and intensive care units 4, 3.

Operator Expertise

• The lumbar puncture in expert hands is a safe test, and the health professional should be suitably familiar with its contraindications, the regional anatomy and the technique used to perform it 2.
• The use of atraumatic needles is associated with a lower incidence of postpuncture discomfort, but they are underused, being used in only 8.0% of cases in one study 3.