Neurodiagnostic procedures: before, during and after

Every neurodiagnostic procedure is made safe by three nursing acts that belong to it — a preparation that screens for what would make that procedure dangerous, a position the nurse places and holds, and an after-care that watches for the complication that procedure carries — so that before a lumbar puncture the nurse looks for the signs of raised intracranial pressure and the bleeding tendency or anticoagulant that make it unsafe and reports them before the needle goes in, confirms consent and an emptied bladder, places the patient side-lying with the knees drawn up and the chin to the chest, or sitting bent forward, and holds them still, labels the specimens in the order they are drawn, and afterwards watches the site for leak and the patient for the headache that is worse upright and eased lying flat and for the fever, neck stiffness or neurological change that mean something worse; before cerebral angiography and contrast imaging asks about a previous contrast reaction, impaired kidney function, metformin and anticoagulants, marks and records the peripheral pulses and the neurological baseline, explains the warm flush and metallic taste so the patient does not move, and afterwards keeps the limb straight, checks the puncture site for bleeding and haematoma and the limb for pulses, colour, warmth and sensation against the baseline, encourages fluids to clear the contrast and repeats the neurological checks, reporting at once a swelling at the site, a cold, pale or numb limb, a new deficit, or the itching, hives or wheeze of a contrast reaction; before magnetic resonance imaging screens for every implanted device and piece of metal, including patches with a metal backing, and for claustrophobia; and before electroencephalography has the hair clean, meals eaten, stimulants avoided and antiseizure drugs held only on the prescriber's order.