What angle and direction should the needle be inserted 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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Answer

Insert the needle at a slightly cephalad angle, directing it toward the umbilicus. Advance the needle slowly but smoothly. Occasionally, a characteristic “pop” is felt when the needle penetrates the dura. Otherwise, the stylet should be withdrawn after approximately 4-5 cm and observed for fluid return. If no fluid is returned, replace the stylet, advance or withdraw the needle a few millimeters, and recheck for fluid return. Continue this process until fluid is successfully returned.


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