Chapter 13: Diagnostic tests
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Post‐procedural considerations
Immediate care
Patients will usually be nursed flat for a period of up to 4 hours in order to reduce the risk of post‐spinal headache. There is no evidence that longer periods are useful (Doherty and Forbes [50]). Follow‐up care will include neurological observations, monitoring for issues such as difficulties with voiding, raised temperature, headache and discomfort. Analgesia and reassurance may be required (Chernecky and Berger [32], Pagana and Pagana [177]).
Ongoing care
If the procedure has been performed in an outpatient setting, the patient may be discharged home after 1–2 hours but with clear instructions to lie flat in transport and at home, and to report any of the following: leakage from the site, headaches, backaches and neurological symptoms. Backache with leg weakness and bladder disturbance may be caused by a spinal haematoma (cauda equina syndrome) and is (usually) a surgical emergency (Chernecky and Berger [32], Doherty and Forbes [50], Pikis et al. [195]).
Documentation
The procedure should be documented in the patient's notes along with a record of informed consent. Any problems or immediate complications should be noted along with any treatment required. The sample bottles must be labelled correctly and sent to the laboratory.
Education of the patient and relevant others
Patients should be informed about relevant signs of complications and be given verbal and written information prior to discharge. Clear instructions should be given about side‐effects and information on whom to call if side‐effects occur.
