This article describes the procedure for performing a lumbar puncture to obtain cerebrospinal fluid (CSF) samples. The technique involves precise needle placement in the spinal column to facilitate CSF withdrawal for diagnostic purposes.
A lumbar puncture is performed by injecting a specialized needle into the spinal column's intrathecal space in the lower back region to withdraw a cerebrospinal fluid, or CSF, sample. To begin, place an anesthetized pig in a right lateral position on a surgical platform. Ensure the spine is flexed, which increases the gaps between the vertebrae.
Take a needle assembly consisting of an inlay needle fitted inside an introducer needle. Locate the space between the fourth and fifth lumbar vertebrae. Pierce the needle through the skin layers and deeper tissues.
Remove the inlay needle and connect a saline-filled syringe to the introducer needle. Push the needle inward while injecting the saline into the spinal column. This step facilitates an easy passage of the needle into the epidural space located around the spinal cord.
Replace the syringe with an inlay needle. Advance the needle to puncture the dura mater - the tissue layer covering the spinal cord. Remove the inlay needle and introduce a lumbar drain tube into the intrathecal space.
Aspirate a small amount of CSF sample to confirm the appropriate positioning of the tube and remove the needle. Suture the drain tube in its position and connect it to a CSF drainage system while monitoring its pressure.
For percutaneous placement of cerebrospinal fluid drainage for measuring and controlling cerebrospinal pressure, identify the level of Lumbar 4 / 5, or L 5 / 6. Puncture the skin, and the subcutaneous space with the introducer needle, and remove the inlay needle. Place a saline-filled syringe onto the introducer needle, and use constant pressure to carefully introduce the needle into the epidural space.
Once a loss of resistance is felt, indicating a correct epidural placement, insert the inlay needle and advance the needle 2 to 3 millimeters into the intrathecal space. Introduce the drainage up to a 20-centimeter depth. Attach a Luer-lock adapter, and verify the position by careful aspiration of the liquor. Then, carefully fix the drainage with sutures, and connect the drainage to the cerebrospinal fluid drainage system.
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