patients may be too ill to sit upright for LP. The patient should
be positioned in a left lateral (for a right handed physician) or
right lateral position (for a left handed physician) for LP.
patient should curl into a fetal position, placing the lumbar spine
in maximal flexion. It may help to support the upper arm to prevent
the upper shoulder from rolling forward. This will in turn create
the greatest interspinous distance (opens the gap) through which
to access the intrathecal space.
patient's back should be at the edge of the bed to allow collection
of fluid easily. A pillow under the head will provide comfort and
keep the spine in a horizontal plane. The shoulders, back and hips
must be perpendicular to the horizontal plane. Incorrect positioning
initially will lead to the spinal needle deviating from the midline
after introduction. This is one of the most common reasons for an
the patient is instructed to “curl up”,
the patient’s upper shoulder may "roll forward”.
The lower shoulder's ability to move forward may also
be restricted if the entire patient’s weight
is upon it. Gently push the lower shoulder in an
anterior direction as far as the patient is able
comfortably, then move the upper shoulder to relatively
the same position.
alternative method of positioning involves placing the patient in
an upright seated position. This can be particularly useful in patients
with whom there is difficulty in landmarking the needle insertion
point (e.g. obese patients).