Lumbar Puncture Procedure

The registrar in charge of organising intrathecal (IT) chemotherapy is the designated lab registrar (contactable via email or pager 8314). A new one will be designated and made known to other staff when registrars change over.

Organising intrathecal chemotherapy

Communicating the IT schedule

Every Thursday or Friday, the lab registrar emails the medical, nursing, and pharmacy staff with details of scheduled ITs for the following week, including the following information:

The "Outpatient Procedure" calendar accessed through CDHB email has the details for all procedures that lab registrars do (i.e. BMA, IT, Hickman line removal). Any staff may email Anne Quick to be added as a viewer, but only lab registrars can edit the dates and times of ITs on this calendar.

At every Friday ward round, the lab registrar informs the whole team about IT chemotherapies for the following week and ensures there are no problems.

Flowchart: Organising Intrathecal Chemotherapy

Method of Lumbar Puncture

Cytarabine or methotrexate should be injected slowly, provided the lumbar puncture has not been traumatic and the CSF blood tinged. Do not withdraw further CSF after injecting the drug, i.e. do not flush.

Following the procedure, the patient should lie flat for at least 1 hour unless they feel this is unnecessary based on their past experience. There is some evidence that the frequency of post lumbar puncture headaches is reduced if the patients lie on their stomach.

Examination of CSF

Subsequent samples should state "Cytospin for Department of Haematology only required". Failure to add the word "haematology" may result in the sample going to Cytology.


About this Canterbury DHB document (5074):
Document Owner:	Sean Macpherson (see Who's Who)
Last Reviewed:	March 2020
Next Review:	March 2023
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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Responsibility:	Action:
The patient's primary consultant	1.	Prescribe IT chemotherapy using the prescription chart.
	2.	Fax the IT chemo prescription and the intravenous prescription charts to the Cytotoxic Suite (81037). Original IT prescriptions must be either: dropped off at the pharmacy, or put in the internal mail addressed to the Pharmacy Department (Cytotoxic Unit).
	3.	Email the lab registrar and the pharmacist so both are aware.
The lab registrar	4.	If appropriate (i.e. due to technically difficult lumbar puncture), book Interventional Radiology (IR). Call the IR suite (81410 or 81082) or outpatient IR bookings (81417) to confirm the IR appointment.
	5.	Email the MDU and B6 CNMs for an available time and location for the IT before emailing the Haem OP nurses to contact the patient with the finalised details.
	6.	Update the "Outpatient Procedure" calendar with the: patient's name and NHI. location and time of the procedure.