What are the steps for needle insertion during a lumbar puncture (LP)?

Updated: Aug 02, 2018
  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Helmi L Lutsep, MD  more...
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Next, stabilize the 20- or 22-gauge needle with the index fingers, and advance it through the skin wheal using the thumbs (see the video below). Orient the bevel parallel to the longitudinal dural fibers to increase the chances that the needle will separate the fibers rather than cut them; in the lateral recumbent position, the bevel should face up, and in the sitting position, it should face to one side or the other.

Spinal needle insertion. Video courtesy of Gil Z Shlamovitz, MD.

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