Lumbar Puncture

Procedures & Monitoring · ICU Decoded chapter 79 · Locked — free with a referral

By Dr Javed Akhtar · Last reviewed 3 October 2026

Cited to IDSA meningitis LP guidance.

Key points

Weigh indication against contraindication, doing CT first with focal signs, seizures, papilledema, immunocompromise, or GCS drop.
Measure opening pressure (in cryptococcus drain to <20 cm) and collect 4 tubes for cells, protein/glucose, Gram stain/culture, and special studies.
Post-dural puncture headache: use a smaller atraumatic needle; blood patch if severe.
In suspected meningitis, never hold antibiotics for the LP.

Investigations

First tests: Blood cultures, Full blood count, Sodium, potassium, bicarbonate, urea and creatinine, Blood glucose.

Only if indicated: Lumbar puncture and CSF studies, Noncontrast CT head, HIV testing.

Repeat monitoring: Neurological and systemic reassessment.

Locked

Why and when to send each test

Open the full chapter in ICU Decoded

Free with a referral from any ICU Decoded member, or by applying with your medical registration. How access works.

← Paracentesis · Thoracentesis →

More in Procedures & Monitoring

Part of ICU Decoded — open the interactive version.

ICU Decoded — original critical-care and internal-medicine pathways by Dr Javed Akhtar, each cited to a current guideline. For education and quick reference; verify every dose against local protocols before prescribing.

Open the app · Ward Pathways — 87 cases · ICU Decoded chapters · Aladin Chirag bedside tools

How to use · About · Medical disclaimer · Privacy · Contact