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A protocol for performing a lumbar puncture and administrating intrathecal chemotherapy in haemato-oncology patients.
Children under the care of the haemato-oncology specialists.
This procedure may only be performed unsupervised by a consultant, specialist registrar or “non-consultant” career grade doctor who is on the intrathecal register.
A lumbar puncture with administration of intrathecal chemotherapy is a procedure that will be required for many patients treated within the haemato-oncology unit in the Royal Hospital for Children, Glasgow. This SOP outlines the procedure of a lumbar puncture.
A lumbar puncture which is performed solely for diagnostic purposes may be performed by any individual trained and deemed competent.
For patients receiving intrathecal chemotherapy it is essential that the related documentation is read and understood. Administration of intrathecal chemotherapy should only be performed by those practitioners who are named on the intrathecal register.
This procedure may only be performed unsupervised by a consultant, trainee or “non-consultant” career grade doctor who is on the intrathecal register, i.e. completed appropriate training and certification in the performance of this procedure (see Appendix 2 and 3 for training/retraining records for supervised medical staff).
The prescription, preparation, collection, administration and checking of intrathecal drugs must comply with the Directorate Policy for Administration of Intrathecal Chemotherapy and the Women & Children’s Directorate Medication Policy.
Intrathecal drugs can only be checked by a registered nurse who has completed appropriate training and certification (on the intrathecal register).
If the child is not having a general anaesthetic, draw up Lignocaine with a 21G needle and 2mls syringe. A separate dressing pack with sterile needles and syringes is used if the patient needs local anaesthetic. It is then disposed of and another dressing pack is used for the lumbar punctures needles. The Lignocaine and lumbar punctures needles should not be on the same trolley.
For further information contact:
Dr Nicholas Heaney via Switchboard on 0141 201 000
Ratified by (via email):
|Head of Nursing & Patient Services:||L Robertson||Date: 18/05/18|
|Lead Clinical Pharmacist:||S Bowhay||Date: 03/05/19|
|Infection Control:||S Dodds||Date: 25/06/18|
This document is intended to inform the practice of oncologists, anaesthetists & anaesthetic assistants performing percutaneous neuraxial procedures
There has been some discussion in the medical literature about recent cases of adhesive arachnoiditis and the role of different skin prep solutions. Contamination of equipment with small droplets of cleaning solution has been implicated. The numbers of cases are small and it’s difficult to draw firm conclusions, however from the evidence available we can agree on some learning points from these case reports;
Do Not pour chlorhexidine in alcohol solution onto an epidural / spinal tray. This risks contamination of equipment with droplets from a splash.
Do Not spray chlorhexidine in alcohol anywhere near an uncovered epidural / spinal trolley. Keep trolleys covered / well away from site being prepped.
Do Not put any swabs used for cleaning back on the trolley
Do always let the skin prep dry fully before touching the skin.
Do check gloves after prepping & if skin prep is on gloves, change before handling epidural / spinal equipment
To adequately prep the skin you may:
Spray the skin with 0.5% chlorhexidine in alcohol (or ask assistant to do this for you)
Use a ‘chloraprep’ 2% chlorhexidine with alcohol swabstick
Chlorhexidine is a more effective skin preparation than Iodine solutions for these procedures
Bogod D. The sting in the tail: antisepsis and the neuraxis revisited. Editorial in Anaesthesia 67: 12, December 2012
Prepared by Dr Graham Bell on behalf of the Anaesthetic Advisory Group 5th December 2012.
Last reviewed: 01 May 2019
Next review: 01 May 2021
Author(s): Dr N Heaney
Approved By: Schiehallion Clinical Governance Group
Document Id: HAEM-ONC-012