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Lumbar Puncture Newborn

  1. Ensure informed consent has been obtained.
  2. Gather necessary supplies and equipment.
  3. Perform hand hygiene and apply clean gloves.
  4. Place the infant on prepared, preheated warmer bed and remove the infant's clothing. Apply the skin temperature probe.
  5. Apply cardiorespiratory and pulse oximetry monitors and activate alarms using appropriate alarm limits for the infant.
  6. Apply eutectic mixture of local anesthetics (EMLA) cream over designated lumbar area as ordered by the physician. Cover with a transparent occlusive dressing or dress per manufacturer's recommendations. Allow EMLA to remain in place for at least 30 minutes prior to the procedure.
  7. Remove gloves and discard in proper trash receptacle. Perform hand hygiene.
  8. Apply cap and mask. Perform hand hygiene and apply clean gloves. Assist the physician with applying sterile gown as needed.
  9. Call or participate in a "time out" before initiating an invasive procedure, in accordance with institutional policy.
  10. Verify the patient's identity using two patient identifiers in accordance with institutional policy.
  11. Assist with establishing a sterile field and preparing equipment. Using aseptic technique, open sterile LP kit and needle package.
  12. Position the infant in side-lying or sitting position as desired by the physician. Bring the infant's knees as far up and close to the chest area as possible, avoiding flexing the infant's neck.
  13. Provide sucrose analgesia or other analgesia per institution-specific policy.
  14. Once the needle is in place, hold the infant in the desired position and restrict movement until the procedure is complete.
  15. Assist with the collection of CSF specimens as necessary. Maintain aseptic technique.
  16. Apply sterile bandage or dressing to LP site once the needle has been removed.
  17. Position the infant supine or per institution-specific policy.
  18. Label specimen tubes at bedside and complete laboratory paperwork per institutional policy. Label each tube with type of specimen and the order in which it was collected.
  19. Remove gloves and discard with supplies in proper trash receptacles. Perform hand hygiene.
  20. Send CSF specimens to the laboratory immediately.
  21. Monitor the infant's neurologic and cardiorespiratory status during and after the procedure.
  22. Monitor the infant for pain according to institution-specific pain scale.
  23. Monitor the puncture site.
  24. Document the procedure in the patient's record.
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