Canterbury DHB

Context

Lumbar Puncture Procedure

Methotrexate (MTX)

Methotrexate is supplied as a 2.5 mg/ml preservative-free solution suitable for intrathecal use. Always double-check that intrathecal injections are preservative-free at these specific low strengths. All intrathecal injections will be clearly marked and issued in designated intrathecal ClickClack containers.

Dose

Usually a dose of 12 mg is given (12 mg/m2 can be given with a maximum of 15 mg). The exact dose depends on the protocol used.

Cytarabine (Ara C)

Dose and Concentration

Should be given in doses of up to 40 mg/m². Check the dose if a specific protocol is being used. Seek consultant advice if more than 100 mg is to be given. Cytarabine is supplied as a 20 mg/mL preservative-free solution for intrathecal use. Always double-check that intrathecal injections are preservative-free at these specific low strengths.

Method of Lumbar Puncture

See Lumbar Puncture Technique, Supportive Care.

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

The CSF obtained requires examination on each occasion.

The examination on patient should include:

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)

Issue Date:

January 2019

Next Review:

January 2022

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 5074