CISTERNAL PUNCTURE – Definition, Purpose, Client Preparation, Procedure and After Care
Cisternal puncture is done mainly if lumbar puncture is contraindicated. One rare occasion, access to the CSF cannot be made by LP and cisternal puncture may be used. Cisternal puncture is performed either to drain CSF or to obtain a CSF specimen when there is block in the subarachnoid space
DEFINITION
Cisternal puncture is puncture of the cisterna magna (a small reservoir of CSF between the cerebellum and medulla). A physician introduces a short-beveled needle below the occipital bone, between the first cervical lamina and the rim of the foramen magnum
PURPOSE
- To drain CSF for increased intracranial pressure
- When LP cannot perform because of deformity or local infection
- To introduce medications directly into the meningeal space
- To inject air or an opaque drug for myelography
CLIENT PREPARATION
- Prepare the client physiologically and psychologically
- Explain the entire procedure in simple words
- Obtain informed consent
- Position the client at the edge of a treatment table or bed, lying on the side with a sandbag under the head to keep the cervical spine and head straight with the thoracic spine
- Check the vital signs and neurological status
- Skin preparation at the puncture site
PROCEDURE
- Place the client on the treatment table on side lying position
- Flex the client’s head forward and hold it firmly in position
- Local anesthetic may or may not be injected
- A cisternal needle with stylet in place is inserted to a depth of about 5 cm
- Gentle and slow withdrawal of CSF done
- The needle is removed by providing pressure over the puncture site
- Mild pressure is applied over the punctured area for few minutes
AFTER CARE
- Provide strict bed rest for 8-24 hours
- Check the vital signs and neurological status
- Check the puncture site frequently for any CSF leakage
- Send the specimen to the laboratory immediately with request
- Replace the articles after washing
- Record the entire procedure in the nurse’s record
