Are these procedures so bad?

CoffeeRTC, BSN, RN · Jun 20, 2008

unless you go into that field, you won't have to deal with this. I think I saw one in nursing school and that was 14 yrs ago.

kmoonshine, RN · Jun 20, 2008

I've helped with lumbar punctures - and they're not that bad. My role has primarily been one of support. I'll give IV meds (either versed or ativan), and remind the patient to keep still. I'll monitor the patient's response to the procedure and intervene accordingly (more meds, calm the patient, etc). The doc does his thing, and gives the specimen samples to the tech, who runs it down to the lab. The docs that I've worked with are really great at what they do, and the patients really have little discomfort, if any.

shelikesmorningglori · Jun 20, 2008

Really?The way spinal taps are portrayed,you would think differently..but is versed a painkiller or an amnesiac(?)

gal220RN, BSN, RN · Jun 20, 2008

Because I do PICU, I see both procedures frequently. They are not nearly as dramatic as you see them House or ER. However, the discomfort for both is greatly diminished by adequate analgesia and sedation- something you can advocate for as a nurse. Remind your dear physicians that an adequately medicated patient makes for a much smoother and quieter procedure- something everyone benefits from in these situations.

BTW- the nurse's role in correctly positioning and holding a patient for an LP is of greater importance than the actual tap. If your position is wrong, you will have a traumatic tap or worse yet, no successful tap at all.

Good luck!

TazziRN, RN · Jun 20, 2008

I've helped with both in the ER. No big deal. You're not actually doing the procedures, just helping by either holding the pt or assisting the doc with meds, equipment, etc.

MisterSimba, BSN · Jun 20, 2008

Really?The way spinal taps are portrayed,you would think differently..but is versed a painkiller or an amnesiac(?)

I got this off of Wikipedia: "Midazolam (marketed under brand names Dormicum, Flormidal, VERSED, Hypnovel and Dormonid, pronounced mɪˈdæzəlæm) is a drug which is a benzodiazepine derivative. It has powerful anxiolytic, amnestic, hypnotic, anticonvulsant, skeletal muscle relaxant and sedative properties. It is considered a short-acting benzodiazepine, with a short elimination half-life. It is therefore a very useful drug to use for short minor procedures such as dental extraction."

I'll be starting nursing school in '09 too....if all goes well! I've found that Wikipedia and WebMD are good sites to get information on drugs. I'm kind of scared about having to take Pharmacology, so I'm trying to learn as much as I can ahead of time :specs:

Good luck to you! :heartbeat

kmoonshine, RN · Jun 20, 2008

Really?The way spinal taps are portrayed,you would think differently..but is versed a painkiller or an amnesiac(?)

Versed is a benzo that has amnesiac/sedative properties. We use it for short procedures that may cause patient discomfort (and therefore complicating the procedure). Splinting a grossly-deformed extremity, putting in an chest tube, performing a lumbar puncture...all things versed works well for. However, its important to also use pain meds too, because versed doesn't help with pain (it just makes you forget that you were having pain).

As another poster said, the nurse assists with positioning the patient and keeping the patient in the proper alignment for the procedure. I've seen nurses that have had to hold infants in position for a lumbar puncture; poor babies! Keeping the patient calm and still is crucial. I stand near the head of the bed with the patient facing me; I actually can't see the lumbar puncture being done, unless I peer over the bed.

JohnnysGirl · Jun 20, 2008

I can give you the point of view from a patient, since I have had both procedures done. As far is it being painful, etc. - it isn't that bad. I would prefer not to have it done again. The first time I had them done, I had a lot of anxiety becuase of the unknown and due to not being able to see what was being done. I could feel the needle in my spine with the tap. There was a slight pinch of pain, but nothing horrible. It was mainly not knowing what to expect that had me so on edge. The bone marrow biopsy was a little worse becuase I could feel the needle in my bone. It didn't hurt, but I could feel what was happening in my bone. I'm glad I couldn't see it done on myself (mainly cuz I could feel it by pressure), but I would find it interesting to see it performed on someone else. I think the biggest issue is anxiety. :twocents:

Daytonite, BSN, RN · Jun 20, 2008

I thought it interesting that you have a fear of these two procedures that are done by physicians. Most people are usually afraid of blood or turned off by cleaning up poop or puke. We fear what we do not know or understand. The way to conquer a fear of something is to learn as much as you can about it. The nurse's role is to help prepare the patient, have the equipment ready for the doctor, and assist the doctor and the patient.

Lumbar Puncture

http://www.nlm.nih.gov/medlineplus/ency/article/003428.htm
http://www.webmd.com/brain/lumbar-puncture
Nurse's Role
- explain the procedure to the patient
- get the consent form signed
- assemble equipment
- provide privacy for the patient
- open the equipment tray and create the sterile field
- make sure the physician has adequate light
- position the patient on his side with his chin tucked to his chest and his knees drawn up to his abdomen so the spine is curved
- remind the patient of the importance of remaining as still as possible during the procedure
- you may need to hold the patient in position to prevent them from making any sudden movements, especially if the patient is a child
- make sure the tubes of CSF fluid that the physician has obtained are properly labeled and get sent to the lab for analysis immediately
- document the time, date, location and patient's tolerance of the procedure, the number of specimens that were obtained and what was done with them
- afterward, observe the patient for headache, drainage from the puncture site, fever, or difficulty urinating

Bone Marrow Biopsy

http://www.webmd.com/a-to-z-guides/bone-marrow-aspiration-and-biopsy
http://www.surgeryencyclopedia.com/A-Ce/Bone-Marrow-Aspiration-and-Biopsy.html
http://www.nlm.nih.gov/medlineplus/ency/article/003934.htm
Nurse's Role
- explain the procedure to the patient
- get the consent form signed
- assemble equipment
- any of the following needles may be requested by the physician: Vim-Silverman, Jamshidi, Illinois sternal, Westerman-Jensen, Jenker's fixative
- a sedative may be ordered to be given to the patient before the procedure
- get a set of vital signs
- position the patient according to the harvest site to be used (posterior superior iliac crest, anterior iliac crest, or sternum)
- you may be asked to hold a sterile gauze pad against the biopsy site after the sample is obtained by the physician to help control the bleeding
- make sure the sample collected is properly labeled and sent to the lab for analysis immediately
- document the time, date, location and patient's tolerance of the procedure, whether or not a specimen was obtained and what was done with it.
- observe the dressing for any drainage or increase in drainage and for fever

Multicollinearity, BSN, RN · Jun 20, 2008

The drama about lumbar punctures being so bad puzzles me. Everyone seems to think they are horrible. Where did that idea come from? I know it's not just the OP that thinks this - it seems to be a commonly held notion.

I had one years back. I did not have any kind of sedative, although I wish I had because I was so afraid. I did not feel pain, though.

JustMe · Jun 20, 2008

"I'll be starting nursing school in '09 too....if all goes well! I've found that Wikipedia and WebMD are good sites to get information on drugs. I'm kind of scared about having to take Pharmacology, so I'm trying to learn as much as I can ahead of time :specs:"
Just an FYI for you students: Wikipedia is not an accepted resource for most colleges. Stick with WebMD, manufacturers' websites, or a good nursing drug book and you won't go wrong with citing your resource.
Just my:twocents: from a clinical instructor.