Step 3 · Skills Checklist

Ultrasound-assisted lumbar puncture (simulation)

Use this checklist on the day. Your faculty member will use the same steps when giving feedback.

Preparation

StepDone
Confirms the indication and checks for NICE contraindications to lumbar puncture without imaging☐
Checks clotting, platelets, anticoagulants and allergies☐
Explains the procedure, alternatives and risks; consent recorded☐
Completes the LocSSIP sign in with an assistant☐

Ultrasound

StepDone
Selects the probe and sets depth and gain☐
Transverse view: finds the spinous process and marks the midline☐
Paramedian view: finds the sacrum and counts up to the chosen interspace☐
Measures the depth to the posterior complex and chooses the needle length☐
Marks a cross; the patient does not move☐

Positioning, asepsis and anaesthesia

StepDone
Positions the patient (lateral if opening pressure needed) with the back vertical and flexed☐
Hand hygiene, sterile gloves; antiseptic allowed to dry; drape☐
Time out before the needle☐
States the maximum local anaesthetic dose; infiltrates, aspirating first☐

Lumbar puncture

StepDone
Midline at the mark, aimed slightly towards the head☐
Advances in small steps with the stylet in; describes the ligamentum flavum and the "give"☐
Confirms CSF; measures opening pressure lying on the side☐
Collects samples in numbered order; paired blood glucose☐
Replaces the stylet before withdrawing; dressing☐

Completion

StepDone
Labels at the bedside and arranges prompt delivery (SAH: last sample, protected from light, by hand)☐
Gives aftercare advice and red flags☐
LocSSIP sign out; documents the procedure fully☐
Remember
This checklist is for simulation practice. Clinical competence is assessed in your workplace, under your employer's procedures.
Sources for this chapter

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