Lumbar Puncture Procedure and Intrathecal Chemotherapy Explained

Transcription

1 Lumbar Puncture Procedure and Intrathecal Chemotherapy Explained Patient Information

2 Introduction This leaflet tells you about the procedures known as lumbar puncture and intrathecal chemotherapy. We hope it will answer some of the questions that you or those who care for you may have at this time. It is not meant to replace discussion between you and your doctor, but helps you understand what is discussed. What is a lumbar puncture? A lumbar puncture (sometimes called a spinal tap) is a procedure where a sample of cerebrospinal fluid (referred to as CSF) is taken for testing. This is the fluid that surrounds the brain and spinal cord. What are the benefits of doing a lumbar puncture? In some forms of leukaemia and lymphoma, tumour cells can occasionally be found in the CSF. Because of this there are two main reasons why you may have a lumbar puncture. A lumbar puncture can be done as a test to find out if there are any diseased cells in the CSF. A small amount of fluid is removed from the spinal cord, and tested to see if it contains any diseased cells. This can help the doctors to decide what sort of treatment is best for you, or to see how well you are responding to your treatment. Secondly chemotherapy can be given directly into the CSF during a lumbar puncture. This is because most forms of chemotherapy drugs, which are given by tablet or intravenous drip, are not able to pass through to the brain, spinal cord or the CSF and cannot attack tumour cells in these areas. Chemotherapy given in this way is called intrathecal chemotherapy. Intrathecal chemotherapy will be offered to you if we know or suspect that there are tumour cells in your CSF. Intrathecal chemotherapy can also be given to prevent tumour cells from causing disease in the CSF in certain patients. These are patients with forms of leukaemia or lymphoma where it is known that untreated there is a high risk of tumour cells going to the CSF. Are there any alternatives to a lumbar puncture? Your doctor has recommended this procedure to you as the best way to find out important information about your illness or as a method of treating you. If you choose not to have the procedure it could delay you receiving important treatment. If you have any questions your doctor will discuss these with you. 1

3 How should I prepare for the procedure? If you are taking aspirin you should stop 10 days prior to the procedure. If you are taking Warfarin you should stop 3 days prior to the procedure. In both cases it is important you speak to your doctor about this as soon as possible, ideally at the time that the lumbar puncture is booked. Before the procedure begins we will take a blood sample. If your platelet count is low then we may need to carry out a platelet transfusion before the lumbar puncture. If this occurs your doctor will explain what is involved. Before the lumbar puncture is performed you will have the procedure explained to you fully by your hospital doctor or nurse. They will be happy to answer any questions that you have. You should let them know if you have any allergies that you are aware of, particularly to iodine cleaning solution, or to plasters. After this explanation you will be asked to sign the hospital consent form. As with all procedures for giving chemotherapy, you may be aware of detailed checks taking place by staff involved in carrying out this procedure. This is because the doctors and nurses involved in preparing and administering intrathecal chemotherapy are part of a highly specialised team. They receive annual training and have undergone an assessment to allow them to take part in the giving of intrathecal chemotherapy. As part of this specialised procedure you will also be offered the opportunity to check the drug that you will receive before it is given. All of these processes are to ensure that you receive the best possible standard of care during your treatment. What happens during the procedure? You will probably be asked to lie on a couch on your side with your knees pulled up against your chest. Sometimes you may be asked to sit up and lean forwards on some pillows. The staff will make sure you are as comfortable as possible. You will need to keep as still as possible during the procedure. The doctor will clean an area of your lower back with an antiseptic and will then inject some local anaesthetic into a small area of skin that lies over a space between two lower vertebrae (spinal bones). This stings a little at first, but then makes the skin numb. A special very fine needle is then put through the skin and tissues 2

4 between two of the vertebrae, and into the space around the spinal cord which is filled with fluid, called cerebrospinal fluid or CSF. Because the skin is numbed with local anaesthetic, most people do not feel pain, but you may feel pressure as the needle is pushed in. Very occasionally, some people do get a sharp feeling in their back or leg when the needle is inserted. Usually a lumbar puncture is a quick procedure but occasionally it can be difficult to get the needle into the correct place. Once the needle is in the correct place, it is usually in for about one to two minutes. When the needle is in the correct position, a small amount of the spinal fluid leaks back through the needle and is collected in a sterile pot, which is then sent to the laboratory to be examined under the microscope. As soon as the required amount of fluid is collected, the chemotherapy will be given through the same needle. This only takes a few seconds and the needle is then taken out and a plaster is put over the site of needle entry. The procedure usually needs repeating although this depends on your particular treatment plan. Sometimes it is repeated weekly, twice weekly or every three to four weeks. Your hospital doctor will have discussed with you how often, and for how long, you will need to be treated in this way. Are there any side effects or risks from a lumbar puncture? Some people develop a headache after the procedure. This usually goes after a few hours. It is best to lie down for a short period of time after the procedure (usually about 30 to 60 minutes) as this makes it less likely that a headache will develop. If you have had previous problems with lumbar punctures it is possible that we could ask you to remain on the bed for as long as six hours before going home to reduce the risk of headaches and dizziness. Other problems are very rare. Rare complications which can occur, usually within the first 48 hours, include infection, bleeding at the site of the needle entry, dizziness, blurred vision, confusion, nausea and vomiting. If you do suffer any side effects you should contact the hospital as soon as possible. Staff training development During the procedure other staff apart from the doctor and nurse may be present to enable us to educate and train new and junior staff, and to 3

5 reassess the more experienced staff. This is part of our commitment to providing high-quality teaching and ensuring excellent care and safety for our patients. If you would prefer not to have anyone else present then you can request for this to happen. The date and time of your first lumbar puncture appointment is: Glossary of medical terms used in this information: Anaesthetic: a drug that causes a loss of feeling or sensation. Chemotherapy: the treatment of cancer with drugs. CSF: cerebro-spinal fluid. A fluid which surrounds the brain and spinal column. Intrathecal chemotherapy: chemotherapy given directly into the cerebro-spinal fluid. Intravenous: fluids given into a vein. Lumbar: relating to the lower back. Vertebrae: the bones which make up the spinal column. Local and national support groups UHB Haematology Support Group Local support group providing information, support and social events for patients with haematological conditions and their families. The group meets monthly. For more information about this group, speak to your key worker or ring Lymphoma Association PO Box No 396, Aylesbury, Bucks HP20 2GA The helpline freephone number is Website 4

6 Macmillan Cancer Support Information line: (Monday-Friday, 9am-8pm) Website Leukaemia Care Society One Birch Court Blackpole East Worcester WR3 8SG Free 24 hour careline: or Tel: Website Myeloma UK Broughton House 31 Dunedin Street Edinburgh EH7 4JG Information line: Tel: Website Leukaemia & Lymphoma Research 43 Great Ormond Street London WC1N 3JJ Tel: Website Local sources of further information You can visit any of the health/cancer information centres listed below: Heart of England NHS Foundation Trust Health Information Centre Birmingham Heartlands Hospital Bordesley Green Birmingham B9 5SS Telephone: Cancer Information and Support Centre Good Hope Hospital 5

7 Rectory Road Sutton Coldfield B75 7RR Telephone: Sandwell and West Birmingham Hospitals NHS Trust The Courtyard Centre Sandwell General Hospital (Main Reception) Lyndon West Bromwich B71 4HJ Telephone: Fax: University Hospital Birmingham NHS Foundation Trust The Patrick Room Cancer Centre Queen Elizabeth Hospital Edgbaston Birmingham B15 2TH Telephone: Walsall Primary Care Trust Cancer Information & Support Services Challenge Building Hatherton Street Walsall WS1 1YB Freephone: About this information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication. We are constantly striving to improve the quality of our information. If you have a suggestion about how this information can be improved, please contact us via our website: This information was produced by Pan Birmingham Cancer Network and was written by Consultant Haematologists, Clinical Nurse Specialists, Allied Health Professionals, Patients and Carers from the following Trusts: Heart of England NHS Foundation Trust 6

8 Sandwell and West Birmingham Hospitals NHS Trust University Hospital Birmingham Foundation Trust Walsall Hospital NHS Trust Worcestershire Acute Hospitals Trust We acknowledge the support of Macmillan in producing this information. Pan Birmingham Cancer Network 2010 Publication Date: July 2010 Review Date: July