Although lumbar puncture can be an important diagnostic procedure, there are times when it is contraindicated.
The APLS Contraindications to Lumbar Puncture [This link is no longer active and therefore I’ve included the link to The Clinical Practice Guideline For Lumbar Puncture from the Royal Children’s Hospital Melbourne. The Clinical Practice Guideline has an excellent list of contraindications to pediatric lumbar puncture.]
- Prolonged or focal seizure
- Focal neurological signs ( including ocular palsies)
- Widespread purpuric rash in ill child
- Glasgow coma score <13
- Pupillary dilatation
- Impaired oculocephalic reflexes
- Abnormal posture
- RICP: inappropriately low pulse, elevated blood pressure and irregular respirations. (indicating impending brain herniation)
Lumbar puncture should also be avoided where there is any cardiovascular or respiratory compromise or if there is local infection at the site of LP.