I have to admit: spinal taps (lumbar punctures) are not one of my favorite procedures to perform. I’m fairly certain our patients don’t enjoy them either. Now imagine performing the procedure on a high-speed train or busy Manhattan subway. Talk about stressful. Well, fear not! Follow these tips below and make your next spinal tap on a moving train the best one yet.
Make sure you and your patient really want to go through with this.
You never know what circumstances will dictate having to perform a spinal tap on a busy train. But before you do anything, make sure the patient wants to go through with it! You might be surprised and find that he or she would prefer to do it in a clinic or hospital setting, in which case, PHEW! If your patient wants to go ahead, then YOU need to not to be so self-conscious for once. It’s just an invasive medical procedure, but this time on public transportation, that’s all.
Maintain your focus.
Do not pay attention to the scenery outside the windows. Don’t worry about that smell, whatever it is. Ignore the arguing couple, babbling drunk, and random mariachi band. Pay no mind to the dog chomping on your calf. FOCUS!
Make you have the right glove size and extra gloves.
Nothing is more embarrassing than having everything in place on the train and realizing, “Darn it! These are the wrong gloves! ARGHHH!!”
Always carry extra lidocaine.
Some patients require more than others. Plus, with the high probability that you will inject into the wrong space if the ride is particularly bumpy, you may want to numb up a larger surface area (the entire back). Though your train will have a fire extinguisher and defibrillator, you’ll be surprised how many do not carry extra lidocaine. Be prepared!
Ask someone to hold the lumbar puncture tray and, later, the CSF tubes.
There’s always one commuter who always dreamed of helping out with a spinal tap. Trust me on this.
Have the patient lie on their side, especially if performing on top of a moving train.
This position allows accurate measurement of an opening pressure. In the event you’re performing the spinal tap ON TOP of a moving train, this position also reduces the risk of major head trauma to your patient when entering into tunnels.
Always point the bevel of the needle towards the emergency exit.
This minimizes the likelihood of cutting the longitudinal dural fibers while maximizing your chance of a safe evacuation in case of an emergency.
Use The Force, Luke!
With all the jostling, bumps, and movement on the train, landmarks are going to do you no good here. Forget about those iliac crests and L3-4 or L4-5. Take a deep breath. Hear Obi-Wan Kenobi’s voice. May The Force be with you, always!
When done, have the patient lie down for 60 minutes across 3 empty seats or 3 commuter’s laps.
Congratulations, you did it! Now make sure you didn’t miss your stop! And above all else: walk the CSF samples to the lab yourself!
