Advance slowly through spinous ligament resistance until you feel some give (sometimes described as a “pop”) with change in resistance as needle enters subarachnoid space.Advance needle slowly in direction of umbilicus with bevel facing upwards (towards the ceiling) if patient in lateral position. Make sure stylet in place before advancing needle.During this time do a final check of your equipment and make sure you have an assistant to help with bottles Wait a few minutes for lignocaine to work.Always check for entrance to blood vessel prior to injection of lignocaine & never inject into spinal canal.With a green (22G) needle advance into subcutaneous tissues.With an orange (25G) needle raise intradermal wheal.Mark entry point with blunt end of needle.Identify & sterilise needle insertion site.Create your sterile area and put on sterile gloves.CSF pressure cannot be reliably measured in this position Flex trunk by having patient lean forward & rest elbows on table or on knees.Useful in patients with pulmonary disorders or potential airway compromise.excessive flexion can compromise upper airway Ensure craniospinal & transverse planes remain stable.Ask or use assistant to draw patient’s legs up to their chest.Knees & torso flexed to optimise interlaminar foramen of vertebrae.
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