This is a demonstration of the steps of performing a Lumbar Puncture on a Gaumard Scientific Trainer. We have been using this trainer for quite some time and it has given us good service. The commentator is Dr Sanjoy Sanyal, Professor and Course Director of Neuroscience and FCM-III Neurology in the Caribbean. It describes the LP procedure from locating the L4 landmark, to positioning the simulated 'patient', to Skin Prepping, to Sterile Draping to Local Anesthesia infiltration, followed by the steps of the actual LP procedure and its conclusion. ACKNOWLEDGMENTS: Special thanks are being extended to Gaumard Scientific and its Vice President, John Eggert, for giving us explicit written permission to use the pictures of Gaumard Scientific in this demonstration. Camera person for this video is Mr. Mark Lessard, IT Administrator par excellence, with his high definition Sony HDR XR520 video camera. The original file, almost 1GB in .MTS format, has been rendered into 400 MB .MPG format, using Ulead Photo Studio, for the purpose of uploading online

1. Dr Sanjoy Sanyal MBBS, MS (Surgery), MSc
(Royal College of Surgeons of Edinburgh),
ADPHA
Professor and Course Director of
Neuroscience – FCM-III Neurology
Watch video here:
http://www.slideshare.net/sanyalsanjoy8
/demonstrating-lumbar-puncture-steps-
on-gaumard-trainer-sanjoy-sanyal

2. Palpate L4
Spinous Process
with both
Thumbs while
feeling both Iliac
Crests with Other
Fingers of both
Hands

3. L4 Spinous Process is on
the Supracristal Plane (Line
joining highest points of
both Iliac Crests)
Head End

4. Chorohexidine
Gluconate with
Alcohol or
Povidone-Iodine
10% and / or
Alcohol
(Isopropyl or
Ethanol)
Povidone-Iodine
is not used in
this trainer
because it will
stain the trainer
Head End

5. Sterile drape with an opening centered over L3-
L4 Interspinous Space is placed over patient
Head
End

6. 0.5 or 1% Lignocaine is infiltrated
subcutaneously at the LP site
Head
End

7. Manometer (Vertical Tube) is
attached to the 3-way Stop-cock, for
use after inserting the LP Needle
Head
End

8. 26-Gauge Tuohy LP Needle with Stylet
inside is advanced through L3-4 Inter-
spinous Space
Head
End

9. Periodically remove Stylet to assess
placement (CSF should drip out)
Head
End

10. CSF dripping out confirms Needle
Placement in Lumbar Cistern
Subarachnoid Space
Head
End

11. Manometer Assembly (with 3-
way Stop-cock) is attached to
Hub of Tuohy LP Needle
Head
End

12. Intracranial Pressure can be read off
from the level of CSF on the vertical
tube (in Millimeters of Water)
Head
End

13. Turn the lever of 3-way Stop-cock to
collect CSF in a Test Tube for analysis
Head
End

14. Remove Tuohy LP Needle by applying a
counter-pressure on skin with left hand,
using a Gauze
Head
End

15. Apply a dressing over LP site using a
sterile gauze or Tincture-Benzoin seal
Head
End

16. The Gaumard Scientific trainer is
in routine use in our medical
institution
Special thanks are being
extended to Gaumard Scientific
and its Vice President John
Eggert for permission to use the
pictures in this presentation.