Spinal puncture: when it is performed, the course of the procedure, decoding, consequences. Take a puncture of the lower horn of the brain

The puncture of the cerebrospinal fluid was described by Quincke about 100 years ago. The analysis of cerebrospinal fluid, which is obtained according to the results of research, allows you to correctly identify diseases, establish an accurate diagnosis and prescribe effective treatment.

This method provides indispensable information in the diagnosis of disorders of the nervous system, the presence of infections and many systemic diseases.

A lumbar puncture is a procedure in which cerebrospinal fluid is removed using a special needle.

Fluid (liquor) is used to test for glucose, certain cells, proteins, and other components.

Often it is examined to identify possible infections.

Spinal puncture is part of most diagnostic studies of diseases of the spine.

Indications

For meningitis

Meningitis is an inflammatory process in the head (often dorsal) meninges. By the nature of the etiology, meningitis can have a viral, fungal, bacterial form.

Meningeal syndrome is often preceded by infectious diseases, and in order to accurately establish the nature and causes of meningitis, the patient is prescribed a lumbar puncture.

During this procedure, the cerebrospinal fluid is examined.

According to the results of the examination, intracranial pressure, the volume of neutrophil cells, the presence of bacteria (hemophilic rods, meningococcus, pneumococcus) are determined.

Lumbar puncture is indicated at the slightest suspicion of purulent meningitis.

With a stroke

A stroke is an acute circulatory disorder of the brain.

A lumbar puncture is prescribed to differentiate a stroke and identify the nature of its occurrence.

To do this, the cerebrospinal fluid is placed in 3 different tubes and the blood admixture in each of the tubes is compared.

With multiple sclerosis

Multiple sclerosis is a disease of the nervous system that affects the brain as well as the spinal cord. The main cause of the disease is considered to be a violation of the immune system.

The disease occurs when the myelin substance that covers the nerve fibers is destroyed and sclerosis (a type of connective tissue) is formed.

Figure: multiple sclerosis

Multiple sclerosis is difficult to diagnose. Therefore, in order to conduct an accurate study, the patient is assigned a study using a lumbar puncture.

When it is carried out, the cerebrospinal fluid is examined for the presence of antibodies (increased immunoglobulin index).

With a positive test result, doctors talk about the presence of an abnormal immune response, that is, multiple sclerosis.

With tuberculosis

If you suspect tuberculosis is required.

It is carried out in order to study the cerebrospinal fluid and determine the volume of sugar, neutrophils, and lymphocytes in it.

In the event of a change in the amount of these substances in the cerebrospinal fluid, the patient is diagnosed with tuberculosis and the degree of the disease is established.

With syphilis

It is indicated for congenital and tertiary forms of syphilis, in case of suspected syphilitic damage to the nervous system (central).

The purpose of the procedure is to identify the symptoms of the disease, as well as the disease itself (syphilis) with its asymptomatic manifestations.

With hydrocephalus

Hydrocephalus is an excess of CSF fluid in the ventricular system of the brain or in the subarachnoid region.

The increased pressure created by the cerebrospinal fluid on the brain tissue can provoke disorders of the central nervous system.

Based on the results of a lumbar puncture, the diagnosis of cerebrospinal fluid pressure in the brain tissues is performed.

When it is removed in a volume of 50-60 ml, the condition of patients in 90% of cases improves for a while.

With subarachnoid hemorrhage

A subarachnoid hemorrhage is sudden bleeding into the subarachnoid region.

Fig.: cerebral hemorrhage

It is accompanied by sudden headaches, periodic disturbances of consciousness.

Lumbar puncture is considered the most reliable, accurate and affordable method for diagnosing subarachnoid hemorrhage. Its purpose is to examine the cerebrospinal fluid for the intensity of blood saturation.

If the test results are positive, the patient is diagnosed with subarachnoid hemorrhage.

With the flu

It is prescribed for influenza in order to establish the factors and signs of a cold and identify possible infections.

Against the background of influenza, mild meningeal syndromes often occur, therefore, in this case, lumbar puncture is considered the most effective diagnostic study.

For other diseases

Lumbar puncture is prescribed:

with suspicion of various forms of neuroinfection;
in the presence of oncological disorders in the brain;
for the purpose of diagnosing hemoblastoses for the appearance of blood blast cells, increasing the level of protein;
for the diagnostic study of normotensive hydrocephalus;
for the purpose of studying disorders of liquorodynamics.

During pregnancy

This procedure is read dangerous for the expectant mother and for the fetus:

it can provoke premature birth or miscarriage:
upon completion of the puncture, a pregnant woman may develop reactions that lead to disruption of the heart, and in some cases to cerebral hypoxia.

In newborns and children

Children are prescribed for:

suspected meningitis, to determine which infection (viral, bacterial) caused the disease;
the need to determine the volume of protein and red blood cells - an insufficient content can cause infectious diseases of varying complexity.

Figure: Lumbar puncture site in children

Contraindications for the procedure

The implementation of a lumbar puncture is contraindicated in:

intracranial hematoma;
post-traumatic brain abscess;
infringement of the brain stem;
traumatic shock;
profuse blood loss;
cerebral edema;
intracranial hypertension;
volumetric formation of the brain;
existing infectious (purulent) processes in the lumbar region;
the presence of extensive damage to the soft spinal tissues;
bedsores of the lumbosacral zone;
axial dislocation of the brain;
occlusive form of hydrocephalus
diathesis of hemorrhagic form;
pathologies of the spinal (cerebral) canals, accompanied by impaired CSF circulation;
subcutaneous infections and their presence in the epidural space;
brain injuries.

Possible complications (consequences)

Complications based on the results of a lumbar puncture appear when the procedure is performed incorrectly.

Violations of diagnostic techniques can cause the emergence of many undesirable consequences:

Post-puncture syndrome. This pathology occurs when epithelial cells are transferred to the membranes of the spinal cord, which leads to expansion and displacement of intracranial vessels.
hemorrhagic complications. These include intracranial hematoma (chronic or acute form), intracerebral hematoma, its spinal subarachnoid form. Improper procedure can damage blood vessels and cause bleeding.
teratogenic factor. It includes epidermoid tumors that form in the canals of the spine, which may appear as a result of the displacement of skin elements into the region of the spinal canal. Tumors are accompanied by aching pains in the lower part of the legs, lumbar region; pain attacks can progress over the years. The reason is an incorrectly inserted stylet or its absence in the needle itself.
Direct trauma. Improper procedure can provoke various damage to the roots (nerve), infectious complications, various forms of meningitis, and damage to the intervertebral discs in the patient.
Complications are liquorodynamic. If a tumor of the vertebral canal develops, then a change in CSF pressure during the procedure can provoke an acute pain syndrome or an increase in neurological deficit.
Change in liquor composition. If foreign bodies (air, various anesthetics, chemotherapy drugs and other substances) are introduced into the subarachnoid region, they can provoke a weak or increased meningeal reaction.
Other complications. Among the minor and quickly disappearing complications are nausea, vomiting attacks, dizziness. Improper implementation of lumbar puncture causes myelitis, sciatica, arachnoid.

Carrying out algorithm

Lumbar puncture is performed by a qualified doctor with the presence of a nurse.

Nurse:

prepares a set for spinal puncture (it consists of sterile cotton wool, iodine solution of 3%, 0.5% solution of novocaine, a special needle, alcohol, sterile gloves, test tubes);
prepares the patient for the procedure;
assists the doctor in the process of manipulation;
provides necessary care for the patient after the procedure.

Photo: CSF puncture needles

To properly perform a lumbar puncture, you must:

place the patient in a certain sitting position;
determine the puncture site, and treat the nearby area with an alcohol solution;
conduct skin anesthesia;
perform a lumbar puncture;
remove the mandrin by placing it in a sterile test tube;
collect a prescribed amount of cerebrospinal fluid for research;
it is necessary to insert a mandrel into the needle, and then carefully remove the needle;
treat the puncture site;
apply a bandage.

Patient preparation

Before starting a lumbar puncture, the patient must notify the attending physician:

about the use of any drugs;
the presence of allergic reactions;
the presence (absence) of pregnancy;
about possible disorders in blood clotting.

The preparation of the patient is subject to certain conditions:

Before starting the procedure, the patient's bladder must be completely empty.
When a lumbar puncture is part of an X-ray examination, the patient needs to clear the bowel to exclude flatulence (intestinal contents) from the image of the spine.
The patient is transported to the ward on a stretcher in his horizontal position (on his stomach).
In the ward, the patient is placed in a sitting position and bent forward or placed in a "side-by-side" position, in which the knees are bent to the stomach. Next, skin anesthesia is performed and the operation itself is performed.

Technique

As a rule, spinal puncture is performed in stationary conditions as follows:

The puncture zone is determined. It is located between 3-4 or 4-5 lumbar vertebrae.
The nearby area is treated with 3% iodine and 70% ethyl alcohol (from the center to the periphery).
An anesthetic solution is injected (5-6 ml is enough). Novocaine is often used as anesthesia.
Between the axillary processes, adhering to the midline, a Bira needle is inserted with a slight slope.
The needle should enter the subarachnoid region (there is a feeling of a needle failure at a depth of 5-6 cm).
When the mander is removed, the cerebrospinal fluid must run out. This confirms the correctness of the procedure. For an accurate analysis, it is necessary to collect about 120 ml of cerebrospinal fluid.
After collecting the cerebrospinal fluid, it is necessary to measure the pressure of the patient.
The injection site is treated with an antiseptic solution.
A sterile dressing is applied.

The duration of the procedure is about half an hour.

What sensations does the patient experience with a lumbar puncture?

With the correct implementation of the procedure, the patient should not feel discomfort, discomfort and pain.

Sometimes the patient may feel:

patency of the needle, which is not accompanied by painful symptoms;
a small injection with the introduction of an anesthetic solution;
the effect of a light current shock if the lumbar puncture needle touches a section of the spinal nerve.
pain in the head (during the implementation of the lumbar puncture, they are felt by about 15% of patients).

Patient care after surgery

Upon completion of the lumbar puncture, patients:

bed rest is prescribed for a day (sometimes bed rest is prescribed for up to 3 days - if certain drugs are introduced into the subarachnoid region).
you must take a horizontal position and lie on your stomach;
it is required to create conditions of rest, provide plenty of drink (not cold);
administer intravenous plasma substitutes (if necessary).

Sometimes after the procedure, the patient experiences:

fever, chills, or tightness in the neck;
numbness and discharge from the puncture site.

In such cases, an urgent consultation with a doctor is required.

results

The purpose of the lumbar puncture is to obtain cerebrospinal fluid and its subsequent study.

Based on the results of a spinal puncture, the cerebrospinal fluid is examined, which can be presented in one of four options:

Blood: indicates the presence of hemorrhagic processes (the initial stage of subarachnoid hemorrhage).
yellowish color: due to the prescription of processes of a hemorrhagic nature (chronic hematomas, carcinomatosis of the meninges, blockade of the CSF circulation in the subarachnoid region).
grayish green color: often indicates the presence of brain tumors;
Transparent liquor- is the norm.

Norm and pathology

The cerebrospinal fluid undergoes a complete study:

CSF pressure is measured;
the liquid is assessed by a macroscopic method;
the volume of protein, sugar is determined;
cell morphologies are being studied.

Norm:

Color of cerebrospinal fluid: transparent
Protein content: 150 – 450 mg/l
Glucose volume: from 60% in blood
Atypical cells: no
Leukocytes: up to 5 mm3
Neutrophils: no
Erythrocytes: no
The norm of liquor pressure is 150-200 water. Art. or 1.5 - 1.9 kPa.

A deviation from the norm may indicate the presence of CSF hypertension.

If the pressure exceeds the norm (more than 1.9 kPa), this is an indication for decongestant therapy. If the CSF pressure has low results (less than 1.5 kPa), this indicates the presence of brain pathologies (sharp edema, blockade of the CSF pathways in the spinal canals).

Besides:

With various pathologies, erythrocytes, neutrophils and pus are detected in the blood.
The presence of abnormal cells may indicate a brain tumor.
A low glucose value is an indicator of bacterial meningitis.

Photo: malignant cells in the cerebrospinal fluid

What can affect the result?

Unfortunately, the result of a lumbar puncture can be affected by:

restless position of the patient during the procedure;
obesity;
dehydration;
severe arthritis;
transferred operations on the spine;
bleeding into the cerebrospinal fluid;
with proper puncture, it is impossible to collect cerebrospinal fluid.

Lumbar puncture can be an invaluable merit in the diagnosis of diseases and infections dangerous to the body.

With proper manipulation, the procedure is absolutely safe.

Video: goals and features of the event

Designed for biopsy of all types of soft tissues (liver, kidneys, thyroid, pancreas, prostate, mammary glands, etc.)

Three groups of needles are used for puncture biopsy: aspiration; modified aspiration; cutting. Aspiration needles have thin-walled cannulas with tips sharpened at different angles and are used for targeted fine-needle biopsy with aspiration of material for cytological examination. Modified aspiration needles have a cannula with sharp sharp edges and tips of various shapes, designed to take both cytological and histological samples. Cutting needles are of three types: Menghini, with a sharpened working end, Tru-Cut, which has a cannula with sharp edges and an internal stylet with a notch, and spring-cutting with a special “gun”. Designed to obtain a tissue sample for histological examination. The technique of execution and diagnostic accuracy of the study depends on the type of needle used and can reach 93-95%, which is comparable to conventional histology.

Sources of information

Diagnostic and therapeutic technique / ed. Mayata V.S. - Moscow, 1969.

Nurse's Handbook for Nursing / ed. Kovanova V. V. - "Medicine", Moscow, 1974. - 464 p. - 255 thousand copies.

Notes

Wikimedia Foundation. 2010 .

Synonyms:

See what "Puncture" is in other dictionaries:

PUNCTION, and, wives. (specialist.). Puncture (tissue, cavity, vessel) for therapeutic or diagnostic purposes. | adj. puncture, oh, oh. Explanatory dictionary of Ozhegov. S.I. Ozhegov, N.Yu. Shvedova. 1949 1992 ... Explanatory dictionary of Ozhegov

PUNCTURE- (punctio), puncture of the cavity with a syringe with a diagnostic or therapist. purpose. P. is used for emptying various kinds of liquids and gases from tissues and cavities (P. emptying), determining their presence (P. test), for bacterial., Chem. and… … Big Medical Encyclopedia

- (from the Latin punctio injection), a puncture of the wall of any body cavity (for example, pleural), joint, vessel, organ, normal or pathological tissue for therapeutic or diagnostic purposes ... Modern Encyclopedia

- (from Latin punctio injection) a puncture of the wall of any body cavity (for example, pleural), joint, vessel, organ, normal or pathological tissue for therapeutic or diagnostic purposes ... Big Encyclopedic Dictionary

PUNCTION, punctures, for women. (lat. punctio injection) (med.). A puncture in the skin, produced by a syringe or some other device for removing or introducing liquids, air or any gases. Explanatory Dictionary of Ushakov. D.N. Ushakov. ... ... Explanatory Dictionary of Ushakov

Exist., number of synonyms: 4 venipuncture (2) culdocentesis (1) paracentesis (2) ... Synonym dictionary

Puncture- (from the Latin punctio injection), a puncture of the wall of any body cavity (for example, pleural), joint, vessel, organ, normal or pathological tissue for therapeutic or diagnostic purposes. … Illustrated Encyclopedic Dictionary

Puncture of the spinal cord (lumbar puncture) can be safely called almost the most complex and responsible diagnostic procedure. Despite the fact that the spinal cord is mentioned in the name, it is not directly affected, but the cerebrospinal fluid, called cerebrospinal fluid, is taken. The procedure is associated with a certain risk, therefore, it is carried out only if there is an urgent need, exclusively in a hospital and by a highly qualified specialist. Why is a spinal cord puncture taken? Most often, spinal cord puncture is used to detect infections (meningitis), in order to clarify the nature of a stroke, to diagnose subarachnoid bleeding, multiple sclerosis, to identify inflammation of the spinal cord and brain, to measure the pressure of cerebrospinal fluid. Among other things, the puncture is carried out in order to administer drugs or a contrast agent during an X-ray examination to determine the presence of a herniated disc. How is a spinal cord puncture taken? During the procedure, the patient is in a lying position on his side, he must press his knees to his stomach, and his chin to his chest. Thanks to the adoption of such a posture, the processes of the vertebrae can be moved apart in order to facilitate the penetration of the needle. The place in the puncture area is disinfected first with iodine, and then with alcohol. Then local anesthesia is performed with an anesthetic (novocaine). Complete anesthesia from the use of anesthetic does not occur, so the patient must tune in to discomfort in advance in order to maintain complete immobility.

The puncture is made with a special sterile needle, the length of which reaches 6 centimeters. A puncture is made in the lumbar spine, usually between the fourth and third vertebrae, usually below the spinal cord. As a result of the introduction of a needle into the spinal canal, cerebrospinal fluid flows out of it. The study usually requires 10 ml of cerebrospinal fluid. In the process of taking a puncture of the spinal cord, the speed of its expiration is estimated. A healthy person has a clear and colorless cerebrospinal fluid, the flow rate of which is about 1 drop per second. If the pressure is increased, the rate of fluid outflow increases, and it can even flow out in a trickle. What is the danger of spinal cord puncture? The spinal cord puncture procedure has been performed for more than 100 years, but patients are often wary of it. One of the widespread myths is the assertion that during the puncture, the spinal cord may be damaged, therefore, paralysis cannot be avoided. As mentioned above, a lumbar puncture is performed in the lumbar region, which is located below the spinal cord, so it cannot be touched. There is also concern about the risk of infection, although the puncture is usually carried out under conditions as sterile as possible. The risk of infection in this case is 1:1000. Other possible complications that may occur as a result of spinal cord puncture sampling include the risk of bleeding (epidural hematoma), the risk that intracranial pressure may increase in patients with tumors or other pathologies of the brain, or the spinal nerve may be injured. Although if a spinal cord puncture is performed by a qualified doctor, the risk is minimal and cannot exceed the risk of performing a biopsy of the internal organs. A lumbar or lumbar puncture cannot be called a simple procedure, as it is aimed at extracting cerebrospinal fluid or, conversely, at the introduction of special drugs. Each person faced with the need for such a procedure is concerned about the degree of pain during the puncture. In general, this indicator can be affected by a person’s pain defect and the skills of a doctor. According to many, this kind of procedure cannot be called pleasant, but it does not cause serious pain. Moreover, before its implementation, soft tissue anesthesia is performed. Accordingly, a person, as a rule, simply feels the penetration of the needle. During the puncture, the needle may touch the spinal nerve, therefore, there may be a sensation similar to a small electric shock. But there is no need to worry about the possibility of harm. It is considered impossible to receive damage from this procedure, because there is no contact with the spinal cord, because the place of removal is chosen where it is absent. Doctors are advised to take a horizontal position after the procedure for several hours, because some patients sometimes suffer from headaches, often not very pronounced, which cannot be removed with painkillers. Headache can be significantly reduced in the supine position. Diagnosis of cerebrospinal fluid is prescribed if a person suffers from nervous and mental diseases. There is a necessary implementation of the procedure in the presence of meningitis, spinal cord injuries, vascular diseases and brain tumors. Also, drugs are sometimes injected into the puncture area, the cerebrospinal fluid is released from blood and after operations from decay products, with the help of a puncture, the pathology of the spinal cord, multiple sclerosis and Guillain-Barré syndrome are determined. Contrast agents are injected to detect hernias.

Spinal puncture is an important step in the diagnosis of neurological pathologies and infectious diseases, as well as one of the methods of drug administration and anesthesia.

Often this procedure is called a lumbar puncture, lumbar puncture.

Thanks to computed tomography and magnetic resonance therapy, the number of punctures performed has significantly decreased.

However, they cannot completely replace the capabilities of this procedure.

Spinal puncture

About the puncture technique

There is a puncture technique that is not allowed to be violated and is the grossest mistake of the surgeon. According to the correct one, such an event should be referred to as a puncture of the subarachnoid space or, more simply, a spinal puncture.

Liquor is located under the meninges, in the ventricular system. Thus, nerve fibers are fed, brain protection is created.

When a disorder occurs due to a disease, the cerebrospinal fluid can increase, causing increased pressure in the skull. If an infectious process joins, then the cellular composition undergoes changes and, in case of hemorrhages, blood appears.

The lumbar region is pierced not only for medicinal purposes to administer the drug, but also to diagnose or confirm the alleged diagnosis. It is also a popular method of anesthesia for surgical intervention on the organs of the peritoneum and small pelvis.

Be sure to study the indications and contraindications when deciding on spinal cord puncture. It is not allowed to ignore this clear list, otherwise the safety of the patient is violated. Of course, without reasons, such an intervention is not prescribed by a doctor.

Who can appoint a puncture?

The indications for such a manipulation are as follows:

alleged infection of the brain and its membranes - these are diseases such as syphilis, meningitis, encephalitis and others;
diagnostic measures in the formation of hemorrhages and the appearance of formations. It is used for information impotence of CT and MRI;
the task is to determine the cerebrospinal fluid pressure;
coma and other disorders of consciousness;
when it is necessary to inject a drug in the form of cytostatics and antibiotics directly under the membranes of the brain;
x-ray with the introduction of a contrast agent;
the need to reduce intracranial pressure and remove excess fluid;
processes in the form of multiple sclerosis, polyneuroradiculoneuritis, systemic lupus erythematosus;
unreasonable increase in body temperature;
spinal anesthesia.

Absolute indications - tumors, neuroinfections, hemorrhages, hydrocephalus.

Sclerosis, lupus, incomprehensible fever - do not oblige to be investigated in this way.

The procedure is necessary in case of an infectious lesion, since it is important not only to diagnose the diagnosis, but also to understand what kind of treatment is required, to determine the sensitivity of microbes to antibiotics.

A puncture is also used to remove excess fluid with high intracranial pressure.

If we talk about therapeutic properties, then in this way it is possible to act directly on the focus of neoplastic growth. This will allow to have an active effect on tumor cells without an elephantine dose of drugs.

That is, the cerebrospinal fluid performs many functions - it detects pathogens, is a carrier of information about the cellular composition, blood impurities, detects tumor cells and tells about the pressure of the cerebrospinal fluid.

Important! Be sure to exclude possible pathologies, contraindications and risks before the puncture. Failure to do so can lead to the death of the patient.

When a spinal tap cannot be performed

Sometimes this diagnostic and treatment procedure can cause more harm and can even be life-threatening.

The main contraindications for which the puncture is not performed:

Puncture procedure

How is the preparation for the procedure going?

Preparation depends on the indications and nuances during the spinal puncture. Any invasive procedure requires diagnostic measures consisting of:

blood and urine tests;
diagnostics of blood properties, in particular, clotting indicators;

Important! The doctor must be informed about the medications taken, allergies and pathologies.

Be sure to stop taking all anticoagulants and angioplatelets a week before the planned puncture so as not to provoke bleeding. It is also not recommended to use anti-inflammatory drugs.

Women before x-rays with contrast should make sure that at the time of the puncture, there is no pregnancy. Otherwise, the procedure may adversely affect the fetus.

If the puncture is performed on an outpatient basis

Then the patient himself can come to the study. If he is being treated in a hospital, then he is brought from the department by medical personnel.

With self-arrival and departure, it is worth considering returning home. After the puncture, dizziness, weakness are possible, it would be good to use the help of someone.

No food or liquid should be consumed for 12 hours prior to the procedure.

The puncture can be assigned to children

The indications are similar in adulthood. However, infections and suspicions of malignant tumors account for the majority.

Without parents, the puncture is not performed, especially when the baby is scared. A lot depends on the parents. They are obliged to explain to the child why the procedure is performed, to inform about the pain, that it is tolerable and to calm.

As a rule, a lumbar puncture does not involve the introduction of anesthesia. Local anesthetics are used. This is done for better portability of the procedure. But, in case of an allergy to novocaine, you can completely refuse anesthesia.

When puncturing, when there is a risk of cerebral edema, it makes sense to administer furosemide 30 minutes before the needle is inserted.

The process of taking a puncture

The procedure begins with the patient taking the correct position. There are two options:

Lying. The person is placed on a hard table on the right side. At the same time, the legs are pulled up to the stomach and clasped with hands.
sitting, for example, on a chair. It is important in this position to bend your back as much as possible. However, this position is used less frequently.

The puncture is made in adults above the second lumbar vertebra, usually between 3 and 4. In children, 4 and 5 to minimize damage to the spinal tissue.

The technique of the procedure is not complicated if the specialist has been trained and, moreover, has experience. Compliance with the rules allows you to avoid terrible consequences.

Stages

The puncture procedure consists of several stages:

Training

The medical staff prepares the necessary tools and materials - a sterile needle with a mandrel (a rod for closing the lumen of the needle), a container for cerebrospinal fluid, and sterile gloves.

The patient takes the necessary position, the medical staff helps to further bend the spine and fix the position of the body.

The injection site is lubricated with iodine solution and then several times with alcohol.

The surgeon finds the right place, the iliac crest, and draws an imaginary perpendicular line to the spine. It is the right places that are recognized as the safest due to the absence of spinal cord substance.

Anesthesia stage

They are used to choose from - lidocaine, novocaine, procaine, ultracaine. It is introduced first superficially, then deeper.

Introduction

After anesthesia, a needle is inserted into the intended place with a cut up at an angle of 90 degrees relative to the skin. Then, with a slight inclination towards the head of the subject, the needle is very slowly inserted deep into.

On the way, the doctor will feel three needle failures:

skin puncture;
intervertebral ligaments;
sheath of the spinal cord.

After passing through all the dips, the needle has reached the intrathecal space, which means that the mandrin should be removed.

If the cerebrospinal fluid does not appear, then the needle should penetrate further, but this must be done with extreme caution due to the proximity of the vessels and to avoid bleeding.

When the needle is in the canal of the spinal cord, a special device - a manometer, determines the CSF pressure. An experienced doctor can determine the indicator visually - up to 60 drops per minute is considered the norm.

The puncture is taken in 2 containers - one sterile in the amount of 2 ml, necessary for bacteriological examination and the second - for the cerebrospinal fluid, which is examined to determine the level of protein, sugar, cellular composition, etc.

Completion

When the material is taken, the needle is removed, and the puncture site is sealed with a sterile napkin and adhesive tape.

The given technique for performing the procedure is mandatory and does not depend on age and indications. The accuracy of the doctor and the correctness of actions affect the risk of complications.

In total, the amount of fluid obtained during the puncture is no more than 120 ml. If the purpose of the procedure is diagnostics, then 3 ml is enough.

If the patient has a special sensitivity to pain, it is recommended to use sedatives in addition to anesthesia.

Important! During the entire procedure, the patient's mobility is not allowed, so the assistance of medical staff is required. If the puncture is performed on children, then the parent helps.

Some patients are afraid of puncture because of the pain. But, in reality, the puncture itself is tolerable and not terrible. Pain occurs when the needle passes through the skin. However, when the tissues are soaked with an anesthetic, the pain subsides and the area becomes numb.

In the case when the needle touches the nerve root, the pain is sharp, as with sciatica. But, this rarely happens and even refers more to complications.

When the cerebrospinal fluid is removed, a patient diagnosed with intracranial hypertension experiences a clear feeling of relief and relief from headache.

Recovery period

As soon as the needle is removed, the patient does not get up, but remains in a supine position for at least 2 hours on the stomach without a pillow. Children under 1 year old, on the contrary, are laid on their backs, but pillows are placed under the buttocks and legs.

The first hours after the procedure, the doctor observes the patient every 15 minutes with a condition control, because the cerebrospinal fluid can run out of the hole from the needle for up to 6 hours.

As soon as there are signs of swelling and dislocation of the brain sections, help is urgently provided

After the puncture procedure, bed rest must be observed. It is allowed to get up after 2 days at normal rates. If there are unusual changes, then the period may increase up to 14 days.

There may be headaches caused by a decrease in fluid volume and a decrease in pressure. In this case, analgesics are prescribed.

Complications

A lumbar puncture is always associated with risks. They increase if the algorithm of actions is violated, there is not enough information about the patient, in case of a serious state of health.

Possible but rare complications are:

If the procedure is carried out in compliance with all conditions, then undesirable consequences almost do not appear.

The stage of studying liquor

Cytological analysis is performed immediately on the same day as the lumbar puncture. When bacteriological culture and sensitivity assessment to antibiotics is necessary, the process is delayed for 1 week. This is the time to multiply the cells and evaluate the response to the drugs.

The material is collected in 3 tubes - for general analysis, biochemical and microbiological.

normal color cerebrospinal fluid clear and colorless, without erythrocytes. Protein is contained and the indicator should not exceed 330 mg per liter.

There is sugar in a small amount and red blood cells - in adults, no more than 10 cells per μl, in children a higher rate is allowed. The normal density of cerebrospinal fluid is 1.005 to 1.008, pH is from 7.35-7.8.

If blood is observed in the received material, this means that either the vessel was injured, or there was a hemorrhage under the membranes of the brain. To clarify the cause, 3 test tubes are collected and examined. If the cause is a hemorrhage, then the blood will be scarlet.

An important indicator is the density of cerebrospinal fluid which changes with disease. If there is inflammation, then it rises, if hydrocephalus - decreases. If at the same time the pH level dropped, then most likely the diagnosis is meningitis or encephalitis, if it increased - brain damage with syphilis, epilepsy.

dark liquid speaks of jaundice or melanoma metastasis.

Cloudy cerebrospinal fluid is a bad sign indicating bacterial leukocytosis.

If protein is increased, then most likely we will talk about inflammation, tumors, hydrocephalus, brain infections.

A puncture is a diagnostic medical procedure during which a special needle is used to puncture an organ and take tissue or fluid for analysis. Also, during the puncture, you can enter a medicine or a contrast agent necessary for further research. Patients who are to undergo this manipulation are interested in how the puncture is done and how painful it is.

What is a puncture for? This question interests many people. In the practice of doctors, these procedures are carried out to diagnose or alleviate the patient's condition in various pathologies.

Existing types:

Pleural puncture. It is done in cases where fluid (exudate, blood) accumulates between the pleural sheets.
Sternal puncture. Such puncture is performed in patients with suspected diseases of the hematopoietic system (aplastic anemia, leukemia, myelodysplastic syndrome).

Spinal puncture. It is indicated for patients with meningitis, brain neoplasms, subarachnoid hemorrhage, neuroleukemia.
Needle biopsy. If malignant neoplasms and various pathologies are suspected, doctors perform a biopsy of the lungs, liver, kidneys, thyroid gland, prostate, ovaries and other internal organs.
Cordocentesis. Puncture of the umbilical vein, during which the blood of the fetus is taken for analysis. This allows you to identify anemia, viral diseases dangerous for the child (toxoplasmosis) and isolate cells for chromosomal analysis.
Puncture of the maxillary sinuses. It is carried out with sinusitis in order to remove stagnant exudate, blood or pus from the maxillary sinuses.

Separately, a follicle puncture is isolated. With it, eggs are taken, which are then used during the in vitro fertilization procedure in infertile couples.

How is a pleural puncture performed?

In what situations is a pleural puncture performed? Manipulation is indicated for conditions that are accompanied by the accumulation of excess fluid between the parietal and visceral pleural sheets.

This occurs when:

Tumors of the lungs.
Tuberculous lesions of the pleura and lungs.
Heart failure.
Bleeding.
Pleural empyema and pleurisy after pneumonia.

Only an experienced surgeon or anesthetist should do a puncture of the pleura, since during manipulation there is a risk of damage to the lungs or large vessels. To perform this type of puncture, patients first do an ultrasound of the chest to accurately determine the level of fluid.

To perform the manipulation, a large thick needle with a diameter of 2 mm and a length of 100 mm is used. With the help of a rubber conductor, the needle is connected to a syringe or container for collecting pathological fluid. During the procedure, to prevent gas bubbles from entering the pleural cavity, the rubber tube is periodically pinched with forceps.

The step-by-step technique of the procedure is as follows:

Before the puncture, the doctor treats the skin in the area of 7–8 intercostal spaces along the posterior scapular line with an antiseptic solution.
Fills a two-cc syringe with 0.5% novocaine.
Pierces the skin and, gradually injecting the anesthetic, slowly inserts the needle until it feels like a "failure".
After that, it pulls the piston and extracts pathological contents with its help - blood, exudate, purulent masses.
Then the specialist changes the needle to a puncture needle and connects it to an electric suction to start the process of pumping out the exudate.

As a rule, the procedure is carried out not only for diagnostic purposes, but also for treatment. With it, a small amount of fluid is taken for analysis and its excess is pumped out, the pleural cavity is washed with medicinal solutions.

When answering the question “is it painful to do a puncture”, it is important to know that a local anesthetic solution is used during the procedure, which minimizes pain.

Usually, patients experience minor discomfort 30-50 minutes after the procedure, when the effect of local anesthesia wears off.

Puncture for pneumothorax

Separately, a pleural puncture is isolated for pneumothorax, a condition that is accompanied by the accumulation of gas in the pleural cavity and compression of the lungs.

This is an emergency. If excess gas is not removed quickly, the lung will collapse and lose its function. In this case, the pleural puncture is carried out using a conventional needle in the 2nd intercostal space along the midclavicular line.

It is important to remember that when puncturing the pleura, the needle must be inserted strictly along the upper surface of the lower rib (in the case of pneumothorax, this is the third rib). This precaution will avoid accidental damage to the intercostal arteries.

Needle biopsy

Puncture and biopsy of internal organs is most often performed with suspicion of malignant neoplasms or purulent processes.

Otorhinolaryngologists in their practice often encounter paratonsillar abscesses, the treatment of which consists in opening and draining the abscess. In order to get rid of such an abscess, the doctor injects the patient's tonsils and the area around them with a local anesthetic, for example, novocaine, then aspirates the purulent masses with a special needle and rinses the cavity with Furacilin solution.

Patients are interested in whether it hurts to take a puncture? Usually, the puncture of a paratonsillar abscess is not accompanied by unpleasant sensations, on the contrary, after it is carried out, patients experience relief.

Puncture of the maxillary sinus

Why take a puncture from the maxillary sinus? This procedure is done for recurring sinusitis that is not amenable to conservative treatment with antibiotics. It can also be used to detect tumors, to determine the conductivity of the anastomosis in the maxillary sinus.

The procedure is simple, it can be done in the manipulation room or directly in the ENT doctor's office. Before the puncture, the toilet of the nasal cavity is carried out and the mucous membrane is treated with a mixture of adrenaline and lidocaine.

At a distance of 2 cm from the inferior nasal concha, a special Kulikovsky needle is inserted. At the same time, its tip should be turned towards the outer corner of the eye from the affected side.
After the implementation of the puncture and the feeling of "failure", the needle is inserted deep into the sinus by 5 mm.
The sinus is washed with antiseptics and a solution of antibiotics.

Puncture of the maxillary sinus is a simple and effective, but rather painful method of treatment, which serves only as an addition to antibiotic therapy for sinusitis.