Lumbar Puncture and Intrathecal Chemotherapy Evaluation
YES
1.
2.
Informed consent obtained including risks of bleeding, infection,
headache.
Sterile technique maintained throughout procedure (sterile gloves,
appropriate chlorhexidine use and draping, technique).
3.
Landmarking (L3-4 or L4-5) and patient positioning appropriate.
4.
Needle inserted with appropriate bevel position (in the saggital plane
of the dural fibres depending on patient position i.e. bevel up with
patient lying on side).
5.
Fluid successfully obtained without using aspiration.
6.
7.
8.
Number of attempts
Appropriate samples collected and sent for the appropriate tests for
patient’s clinical condition.
Chemotherapy drug, dose and syringe volume verified correct along
with identity of patient.
9.
Chemotherapy infused over 3-5 minutes by slow direct push.
10.
Appropriate counseling around potential complications is performed
and monitoring for complications arranged.
11.
Disposes of sharps safely
Overall, this learner performed the lumbar puncture procedure (please circle one):
Independently
With assistance
Resident name
Evaluated by
Date
Office use only: number
of 5
NO