Lumbar Puncture Checklist → Clinical Note Generator
Procedure Date:
Time:
Operator:
Supervisor:
BEFORE THE PROCEDURE
Indication documented?
Imaging reviewed?
Yes
No
N/A
Contraindications checked?
Yes
No
Drug chart checked for anti-coagulants?
Yes
No
Coagulation checked?
Yes
No
CONSENT
Patient has capacity?
Yes
No
Consent discussion completed?
Yes
Best interests
PROCEDURE DETAILS
Aseptic technique used:
Sterile gown & gloves
Hat & mask
Sterile drape
0.5% chlorhexidine
Position:
Lateral
Sitting
Level:
L2/3
L3/4
L4/5
Needle used:
CSF appearance:
CSF SAMPLES SENT
Number of white top bottles sent to lab:
Consider sending a 4th white top “save” sample for future investigations
MC&S
Virology
Protein
Glucose
Xanthochromia
Other:
ADDITIONAL COMMENTS
Generate Text Note