Most important thing for a nurse to do after a spinal tap?

  1. Is it push fluids or make sure they lay flat? Maybe neither of those are the *MOST* important?

    I think that the most important thing to do is make sure they lie flat, b/c if they get up, the puncture could lose it's coagulation. My instructor, however, didn't really stress what is most important, and my classmates think it's most important to make sure they drink plenty of water, unless there is a fluid restriction on that patient.

    My instructor just said "The doc will order how long they should lie flat for, and it's usually not very long. It helps prevent a bad headache. Make sure they get plenty of fluids in."
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  2. 12 Comments

  3. by   LadyK82
    I would have to say lying flat and applying pressure to the area. I know fluids are important, but they can't drink fluids if they're bleeding to death. I know with a liver biopsy you have to lay on the right side and on our test it was the priority nursing action, so I'm assuming the same would be true of a spinal.
  4. by   LPN_mn
    I just recently had a spinal tap and in my opionion, as the patient, I would have to say lay flat. Mine was done in ER and was sent home within 1 hour after having procedure done. IMHO this was way to soon to be up because I had severe headaches for >1 week ended up having a patch done to get rid of the HA. Doctor stated if they had kept me laying flat for at least 3-4 hours I probably would not have had the HA. I told him I would rather be in labor then to deal with the intensity of those HA's.
  5. by   mattsmom81
    Prevention of leak is number one goal IMHO and that involves laying flat (1 hr is waay to soon to let someone up)asessment and care of the site. But...go by what your instructor says.
  6. by   All_Smiles_RN
    I'd say monitor for signs of infection.
  7. by   ManyRN2B
    Lay flat is very important. It's so the CSF can gain equilbrium back again. Fluid shift.....Something like that equilbrium may not be the right word. Like someone else said, spinal headache if not.
  8. by   Joeknee
    Quote from jenniferhelene
    I'd say monitor for signs of infection.
    S&S of infection wouldn't set in until much later.
  9. by   crb613
    Quote from LPN_mn
    I just recently had a spinal tap and in my opionion, as the patient, I would have to say lay flat. Mine was done in ER and was sent home within 1 hour after having procedure done. IMHO this was way to soon to be up because I had severe headaches for >1 week ended up having a patch done to get rid of the HA. Doctor stated if they had kept me laying flat for at least 3-4 hours I probably would not have had the HA. I told him I would rather be in labor then to deal with the intensity of those HA's.
    I am with you lay flat!! I had a spinal tap done some time ago & the headache was horrible!! They did keep me flat but the vomiting & HA was soooo bad. I had the darn thing (HA) for a week or so bad, bad, bad. It would have to life/death before I would ever have it done again.
  10. by   ManyRN2B
    I remember! :roll the reason you lay on your back is so the fluid can replinsh. I said equalize........

    I'm pretty sure that is why. The fluid has to rebuild.
  11. by   mel82
    I just had this question on a test yesterday and I put drink fluids. According to my NCLEX review book this is the answer.

    HTH, Melanie
  12. by   dianacs
    I think it's laying flat so that the site stays intact.
  13. by   athomas91
    I would have to say lying flat and applying pressure to the area
    what?!?!? pressure to the area doesn't help anything when the subarachnoid space has been entered (spinal tap)

    and unfortunately especially if you are under the age of 50 your risk of spinal headache is increased even if you lay flat for 2 wks. It all depends on what type of needle they used to do the tap. IV fluids is a great thing for a nurse to give to one who has had this procedure. and laying flat for one hour is fine - then send them home and tell them to continue to lay down for a few more hours. other than that - there is nothing you can do. most spinal headaches (if true spinal headaches) are positional ie. they are relieved by laying down and worsened by standing. if intolerable - you should let your doctor know - or return to the ER and anesthesia can do a blood patch which fixes the problem.
  14. by   z's playa
    I'd like to add my experience with LPs. As a lot of you know I get migraines and earlier on I used to get them quite infrequently..and I would present in the ER with "the worst headache ever"....because they were! Well as you know that's the red flag for CT and LP especially with fever, which I coincidently had at the time. I thought my head hurt BEFORE the tap. Let me tell you! It was 2x as bad after. So my point is...if the pt comes in with headache and the doctor has already prescribed pain meds (NSAIDS or narcs..) please make sure the pt gets more meds after the procedure along with the fluid if he/she complains of worsening pain. Believe me. It happens.

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