Lumbar Puncture

Lumbar puncture can be important for treatment if the clinical diagnosis is in doubt particularly, in children who are febrile without a focus. For children with obvious meningeal symptoms, microbiological confirmation is valuable for

However, LP must not be performed when there are contraindications and should never delay treatment. With modern PCR techniques, CSF samples may still be positive after antibiotics have killed the organisms.
Check with a senior colleague if you are unsure.


Before attempting lumbar puncture assess HR, RR, BP, CRT, pupils, rash, fundal examination for papilloedema.
Make sure there are no signs of raised intracranial pressure or shock.


The APLS Contraindications to Lumbar Puncture 30
  • Prolonged or focal seizure
  • Focal neurological signs ( including ocular palsies)
  • Widespread purpuric rash in ill child
  • Glasgow coma score <13
  • Pupillary dilatation
  • Impaired oculocephalic reflexes
  • Abnormal posture
  • RICP: inappropriately low pulse, elevated blood pressure and irregular respirations. (indicating impending brain herniation)
  • Coagulopathy
  • Papilloedema
  • Hypertension

Lumbar puncture should also be avoided where there is any cardiovascular or respiratory compromise or if there is local infection at the site of LP.



CLOSE