How and why they take a puncture. What is a puncture? Indications for prescription and consequences of puncture Patient's condition after brain puncture

A puncture is a specific procedure that is used to diagnose pathologies, as well as treat internal organs, biological cavities. It is done using special needles and other devices. Before agreeing to such a procedure, it is necessary to consider in more detail what a puncture is, what features it has and how it is carried out.

A puncture is a special puncture of the tissues of internal organs, blood vessels, various neoplasms, cavities for taking fluids in order to diagnose pathologies. In addition, the application of the procedure in some cases is necessary for the administration of drugs. It is used to diagnose pathologies of the liver, bone marrow, lungs, and bone tissue. Basically, in this way, cancer is determined. To clarify the diagnosis, materials are taken directly from the tumor. As for the blood vessels, they are punctured for the collection of biological fluid, the installation of catheters through which drugs are administered. Parenteral nutrition is produced in the same way.

If an inflammatory process is observed in the abdominal, articular or pleural cavity, accompanied by accumulation of fluid or pus, then a puncture is used to remove this pathological content. For example, with the help of this procedure, drains are installed for washing the internal organs, administering drugs.

Regarding puncture, this is a mandatory procedure used in anesthesiology, especially during operations on the limbs. It is common in gynecology to determine a number of diseases and treat them.

Indications for the use of the procedure in gynecology

So, for the use of a puncture puncture, there must be appropriate indications. They do it in order to:

• confirm ectopic pregnancy or female factor infertility;
• determine the presence of rupture of the uterus or internal organs;
• exclude peritonitis;
• counting the number of oocytes in the ovaries;
• determine the amount and nature of exudate in the organ cavity, tumors;
• diagnose internal endometriosis, as well as other neoplasms of a malignant or benign nature;
• determine the violation of the menstrual cycle, uterine bleeding of unspecified origin;
• diagnose or exclude anomalies in the development of the reproductive organs of a woman;
• to carry out the sampling of material to determine the effectiveness of the treatment;
• to select eggs during the IVF procedure.

After the puncture, the patient can go home the very next day only if a serious illness is not diagnosed.

Varieties of puncture in gynecology

There are several types of punctures that are used to diagnose and treat female diseases:

All of these types of punctures are used in gynecology in difficult cases when diagnosis or treatment in another way does not give a positive result.

General rules for piercing

Many women are interested in how a puncture is done. In most cases, it is painless. However, in order for the procedure to pass without complications, as well as for the psychological comfort of the woman, anesthesia or anesthesia is necessary. There are other rules for puncture:

1. Before the procedure, all instruments, as well as the external genitalia, must be treated with a disinfectant solution. This will avoid additional infection of internal tissues and cavities.
2. If the puncture is made through the back wall of the vagina, then the movement should be sharp and light. At the same time, care must be taken not to damage the wall of the rectum.
3. If there is a very thick exudate in the cyst or cavity that can clog the needle, it is necessary to inject a sterile solution inside.
4. Puncture is allowed only in specialized clinics or medical offices.

The procedure is quite complex, so it should be carried out by an experienced specialist with a good reputation.

Possible consequences

In general, the diagnostic operation is painless, but sometimes the following consequences of a puncture can be observed:

• trauma to the blood vessels or endometrial layer of the uterus;
• decrease in pressure (during operations accompanied by serious blood loss);
• in the organ or cavity in which the puncture is made;
• damage to the rectum (often additional treatment is not required);
• general deterioration of well-being;
• dizziness;
• scanty vaginal discharge;
• dull pain in the abdomen;
• incorrect diagnosis (blood in the fluid may appear not due to a disease, but due to damage to the vessels located in the periuterine tissue).

Puncture in gynecology is a frequently used tool for the diagnosis and treatment of pathologies of the reproductive system. It can be done only on the prescription of a doctor in a medical institution.

Spinal puncture (lumbar or lumbar puncture), as a diagnostic or therapeutic procedure, has been used by doctors for a long time. In connection with the introduction of new diagnostic methods (CT, MRI, etc.) into medical practice, the frequency of this intervention has noticeably decreased, however, it still remains relevant.

Anatomical details

In humans, it is located in the bone canal formed by the vertebrae. At the top, it directly passes into the medulla oblongata, and at the bottom it ends with a sharpening, having a conical shape, at the level of the second lumbar vertebra.

The spinal cord is covered by three outer membranes: hard, arachnoid (arachnoid) and soft. Between the arachnoid and soft membranes is the so-called subarachnoid space, which is filled with cerebrospinal fluid (CSF). The average volume of cerebrospinal fluid in an adult is 120-270 ml and continuously communicates with the fluid of the subarachnoid space of the brain and cerebral ventricles. The spinal membranes end at the level of the first sacral vertebrae, that is, much lower than the location of the spinal cord itself.

Strictly speaking, the term "spinal cord puncture" is not entirely correct, since during this manipulation, a puncture of the subarachnoid space is performed at a level where spinal structures are absent.

Characteristics of the cerebrospinal fluid

Liquor is normally completely transparent and colorless. It is practically possible to estimate the pressure by the rate of flow of CSF from the lumen of the needle: approximately 1 drop per 1 second corresponds to the norm.

If the cerebrospinal fluid is taken for the purpose of further laboratory analysis, then the following indicators are determined:

If an infectious lesion of the membranes of the spinal cord and / or brain is suspected, a bacterioscopic and bacteriological examination of the cerebrospinal fluid is also performed to identify the pathogen.

Methodology

Puncture of the spinal cord should be performed exclusively in a hospital by a specialist who thoroughly knows this technique.

Manipulation is performed in the position of the patient sitting or lying down. The most preferred position is lying on the side with the knees strongly pressed to the chest, the head lowered as much as possible and the back bent. In this position, the intervertebral spaces increase, as a result of which the risk of unpleasant consequences during the manipulation is reduced. It is important to remain still throughout the procedure.

The spine is punctured at the level between the third and fourth lumbar vertebrae. In children, a lumbar puncture is performed between the fourth and fifth lumbar vertebrae (taking into account the age-related anatomical features of the spinal structures and spine).

The sequence of actions of the doctor:

1. The skin is treated with any antiseptic solution (for example, iodine and alcohol).
2. Spend local anesthesia (for example, novocaine solution) of the puncture site.
3. The puncture is performed at a certain angle between the spinous processes of the lumbar vertebrae. For this, a special needle with a translucent mandrel is used.
4. The appearance of liquor indicates a correctly performed procedure.
5. Further actions are determined by the purpose of the manipulation: cerebrospinal fluid is taken for analysis (in a volume of approximately 10 ml), drugs are injected into the subarachnoid space, etc.
6. The needle is removed, the puncture site is sealed with a sterile bandage.

After the end of the procedure, the patient turns over on his stomach and stays in this position for at least two hours. This is carried out in order to prevent such consequences as post-puncture syndrome associated with the outflow of fluid through a defect in the hard shell.

It is important to know that, despite the ongoing anesthesia, the moment of the puncture may be accompanied by discomfort.

Why do a lumbar puncture?

Spinal cord puncture is performed for various purposes. The main ones include:

• Collection of cerebrospinal fluid for its subsequent analysis.
• Assessment of cerebrospinal fluid pressure, study of the patency of the subarachnoid space using special compression tests.
• The introduction of drugs into the spinal canal, such as antibiotics or cytostatics.
• Removal of excess amount of cerebrospinal fluid in certain diseases.

Most often, spinal cord puncture is used for diagnostic purposes. In what cases is it used:

• Subarachnoid bleeding in the brain and spinal cord (for example, or injuries).
• Some infectious diseases - meningitis, encephalitis, ventriculitis, neurosyphilis and others.
• Malignant lesion of the membranes of the spinal cord and/or brain.
• Suspicion of liquorrhea or the presence of cerebrospinal fluid fistulas (using dyes or contrast agents).
• Normotensive.

Also, a spinal cord puncture is sometimes done for fever of unknown etiology in early childhood (up to two years), demyelinating processes, paraneoplastic syndrome, and some other pathologies.

Contraindications

There are also contraindications for this procedure. These include:

• Conditions in which there is a high risk of axial herniation - severe cerebral edema and intracranial hypertension, occlusive hydrocephalus, some brain tumors, etc.
• Infectious and inflammatory processes in the lumbar region.
• Serious violations of the coagulation system, the use of drugs that affect blood coagulation.

In any case, indications and contraindications for such a procedure are established exclusively by a doctor.

Complications

Like any invasive procedure, lumbar puncture has its complications. Their frequency averages up to 0.5%.

The most common consequences of a lumbar puncture include:

• Axial herniation with the development of dislocation (displacement of structures) of the brain. This complication often develops after a sharp decrease in the pressure of the cerebrospinal fluid, as a result of which the structures of the brain (more often the medulla oblongata and part of the cerebellum) are "wedged" into the foramen magnum.
• The development of infectious complications.
• The occurrence of headaches, which are usually stopped in the supine position.
• Radicular syndrome (the occurrence of persistent pain as a result of damage to the spinal roots).
• Meningeal manifestations. Especially often they develop with the introduction of drugs or contrast agents into the subarachnoid space.
• The formation of an intervertebral hernia as a result of damage to the cartilage tissue of the disc.
• Bleeding and other hemorrhagic complications.

When a spinal puncture is performed by an experienced specialist with an assessment of all indications and contraindications for this procedure, as well as strict adherence by the patient to the instructions of the attending physician, the risk of complications is extremely low.

Puncture of the ventricles of the brain (ventriculopuncture) is performed for diagnostic and therapeutic purposes. Especially important for the patient is the puncture of the ventricles of the brain in the provision of emergency care during the period of the hypertensive-hydrocephalic crisis, being often the only measure that allows the patient to be taken out of a serious condition. There are no contraindications for ventricular puncture, except for bilateral brain ventricular tumors.

The anterior and posterior horns of the juice ventricles are most often punctured; the lower horns are rarely punctured.

Puncture of the temporal horns of the lateral ventricles is performed with an unsuccessful puncture of the anterior and posterior horns or during an operative intervention in the temporal region of the brain, as a stage.

The patient is prepared for a puncture of the lateral ventricle of the brain (if it is not done on an emergency basis) as for an operation: the night before, they put a cleansing enema, make a hygienic bath, shave their head baldly on the eve or on the day of the operation, do not feed or drink in the morning on the day of the study.

Puncture of the ventricles of the brain is performed under local anesthesia with 30 ml of 2% novocaine solution.

Puncture of the anterior horn of the lateral ventricle

The position of the patient on the back face up. After double treatment of the scalp with a solution of iodonate or iodopyrone, a 1% solution of brilliant green is used to mark the incision line of the soft tissues of the head, passing parallel to the sagittal suture through the Kocher point, dividing the incision line in half. Projection of the Kocher point on the scalp: 2 cm anterior and 2 cm outward from the intersection of the sagittal and coronal sutures of the skull, which are determined by palpation through the scalp or restoration of a perpendicular line from the middle of the zygomatic arch to the intersection with the sagittal suture. Then the operating field is isolated with a sterile sheet. The edges of the wound are moved apart with a Jansen retractor, a burr hole is applied with a large cutter, the remnants of the vitreous plate are removed with a Volkmann spoon. Bleeding from the bone is stopped by rubbing wax into the bone. The visible vessels of the dura mater are coagulated, it is cross-cut. The vessels of the choroid of the brain are coagulated. A spinal puncture needle (or a special cerebral cannula) is inserted into the brain to a depth of 4.5-5.5 cm parallel to the median plane on a mentally drawn line connecting both auditory canals (biauricular line). When the needle enters the cavity of the lateral ventricle, ventricular fluid begins to flow from it. In this position, the needle is fixed with a rubber retainer, gauze balls and other methods so that it does not move. Fluid is removed from the ventricle slowly under the control of the extracted mandrin.

Puncture of the posterior horn of the lateral ventricle

The position of the patient on the stomach face down. The head should be positioned in such a way that the line of the zygomatic process of the temporal bone is strictly vertical, and the line of the sagittal suture is strictly in the median plane. The entire shaved scalp, forehead, auricles, back of the neck are treated twice with a solution of iodonate or iodopyrone. An incision line of the scalp is outlined with a 1% solution of brilliant green, which runs parallel to the arrow-shaped seam through the Dandy point, dividing the incision line in half. Projection of the Dandy point on the scalp: 4 cm anteriorly and 3 cm outward from the external occipital protuberance of the skull, palpated through the soft integuments of the head. Limit the operating field with sterile linen. The incision of the soft integument of the head, the imposition of a burr hole, the dissection of the dura mater is performed in exactly the same way as when accessing the anterior horn of the lateral ventricle. Needle 18, which punctures the ventricle, is inserted into the brain to a depth of 5-6 cm in the direction of the outer-upper angle of the orbit of the same side.

Puncture of the inferior horn of the lateral ventricle

The position of the patient lying on his side. The scalp and auricle are treated twice with a solution of iodonate or iodopyrone. An incision line of the scalp is outlined with a 1% solution of brilliant green, passing in the vertical direction through the Keen point, dividing the incision line in half. Projection of a point on the scalp: 3 cm above and 3 cm posterior to the opening of the external auditory canal. Limit the operating field with sterile linen. An incision of the soft integument of the head, the imposition of a burr hole, dissection of the dura mater are performed in the same way as when accessing the anterior horn of the lateral ventricle. The needle, which punctures the ventricle, is inserted in the direction of the upper edge of the opposite auricle to a depth of 4-4.5 cm.

Complications of puncture of the ventricles of the brain

1) When dissecting the dura mater, it is possible to injure a vein passing from the cerebral cortex to a duplication of the dura mater, which can lead to the formation of a subdural hematoma; 2) the occurrence of intracerebral hematoma as a result of injury to the cerebral vessel; 3) when a large amount of ventricular fluid is excreted and the volume of the brain decreases, a break in the cortical vein that flows into the sinus of the dura mater and the formation of a subdural hematoma is possible; 4) hemorrhage into the ventricle of the brain when the vascular plexus of the lateral ventricle was injured with a needle; 5) hemorrhage into the tumor when the tumor vessels are injured with a needle; 6) hemorrhage into the tumor with a sharp decrease in intracranial pressure; 7) growth of the brain and increased intracranial pressure during repeated unsuccessful punctures of the ventricle of the brain.

A lumbar puncture, or lumbar puncture, is a diagnostic or therapeutic procedure performed on an outpatient basis using local anesthesia. The purpose of a diagnostic lumbar puncture is to take a sample of cerebrospinal fluid, the laboratory study of which will confirm or exclude the suspicion of any diagnosis. For therapeutic purposes, the collection of a certain volume of cerebrospinal fluid is most often used to reduce intracranial pressure or administer drugs.

Some anatomical characteristics of the structure of the spinal cord and its membranes

The spinal cord is the main channel of information transmission connecting the brain and the peripheral nervous system, which innervates all organs and tissues located below the base of the skull. The organ is enclosed in the spinal canal, which runs inside the bone base of the vertebrae. A characteristic feature of the spinal cord is that its length is much shorter than the spinal column. The spinal cord originates as a continuation of the medulla oblongata and reaches the second lumbar vertebra, where it ends in the form of a fibrous extension called the terminal filaments or "horse tail".

The total length of the spinal cord in an adult, regardless of his height, is:

• for men - 45 cm;
• for women - about 43 cm.

In the region of the cervical and lumbar sections of the spinal column, the spinal cord forms characteristic thickenings, from which large numbers of nerve plexuses depart, causing a separate innervation of the thoracic and pelvic limbs, respectively.

Being in the lumen of the spinal canal, the spinal cord is sufficiently protected from external physical influences by the thickness of the bones of the spinal column. In addition, throughout the entire length of the body is shrouded in three successive layers of tissues, providing its additional security and functional tasks.

• Dura mater is the outer layer lining the spinal canal, to which it does not adhere tightly - a cavity called the epidural space is formed between the shell and the walls of the canal. The epidural space is mostly filled with adipose tissue and permeated with a wide network of blood vessels, which provides cushioning and trophic needs of nearby tissues, including the spinal cord.
• Arachnoid or arachnoid meninges is the middle layer covering the spinal cord.
• Pia mater. Between the arachnoid and pia mater formed the so-called subarachnoid or subarachnoid space, which is filled with 120-140 ml of cerebrospinal fluid(liquor of the subarachnoid space) in an adult, it is abundantly saturated with a network of small blood vessels. It is worth noting that the subarachnoid space is directly connected with the same name in the skull, which ensures a constant exchange of fluid between the cranial and spinal cavities, the boundary between which is the opening of the fourth ventricle of the brain.
• At the end of the spinal cord, the cauda equina nerve roots float freely in the cerebrospinal fluid.

Biologically, the arachnoid is represented by a network of intertwining threads of connective tissue that looks like a web, which determines its name.

It is extremely rare to combine the arachnoid and pia mater, giving them a common name leptomeningx, and the dura mater is isolated as a separate structure, pachymeninx.

When is a lumbar puncture necessary?

Lumbar puncture is performed from the lumen of the subarachnoid space between the dura and arachnoid mating of the spinal cord in the lumbar spine, where the spinal cord completes its length. This area allows you to reduce the risks associated with physical damage to the spinal cord.

Taking cerebrospinal fluid with diagnostic indications is carried out due to the exclusion of infectious, inflammatory and neoplastic pathologies that can have a detrimental effect on the central nervous system.

Most often the reason for the fence may be a suspicion of meningitis , for the diagnosis of which there is no more reliable way than a laboratory study of cerebrospinal fluid.

Large concentrations of colonies of trypanosomes (microorganisms) that cause a rare but very serious human infectious disease known as sleeping sickness or African trypanosomiasis found in the cerebrospinal fluid.

In newborns, a lumbar puncture is often performed in order to exclude complications in the form of meningismus, when a fever of unspecified etiology is detected and genesis.

In addition, at any age, a number of diseases can be confirmed or ruled out using a laboratory study of cerebrospinal fluid.

• Subarachnoid hemorrhage.
• Multiple sclerosis.
• Hydrocephalus.
• Benign intracranial hypertension and other non-contagious pathologies.

One of the most common indications for spinal puncture is the suspicion of malignant oncogenesis in the central nervous system. Carcinomatous meningitis and medulloblastoma often cause the presence of free-floating metastatic formations in the cerebrospinal fluid.

Therapeutic spectrum there are several indications for a lumbar puncture at same. Often, antibiotics are injected into the lumen of the subarachnoid space in case of pathologies of the infectious series in order to quickly deliver the drug to the pathological focus and accumulate it in sufficient concentration. In some malignant oncopathologies of the brain and spinal cord, cerebrospinal fluid is used as a delivery vehicle to provide the necessary doses of chemotherapy around the tumor.

In addition, a puncture is used when surgery is required in the region of the spinal column.

pumping out the required amount of cerebrospinal fluid is often indicated with increased intracranial pressure arising, as a rule, due to cryptococcal meningitis or hydrocephalus with normal intracranial pressure.

Contraindications for lumbar puncture

This pathological condition is characterized by separate displacements of some cerebral regions relative to their normological location. This phenomenon occurs due to increased intracranial pressure, when physical forces stimulate the invagination, wedging or infringement of the brain parenchyma and, as a result, its pathological contact with the anatomical features of the cranial bones. Most often, the effects of the formation of hernial infringements of the brain into separate cavities filled with cerebrospinal fluid, which physiologically serve as a CSF reservoir, are observed.

The intake of cerebrospinal fluid helps to reduce intracranial pressure, and this situation can unpredictably affect the displacement of the brain, which in the vast majority of cases leads to a sudden death.

Thus, lumbar puncture as a therapeutic effect with increased intracranial pressure is carried out with great care, having previously completely excluded cerebral dislocation phenomenon.

Technique for puncture of cerebrospinal fluid

The puncture technique is not particularly difficult, however, the procedure is allowed for specialists who have experience in puncturing or who have undergone training on artificial emulators.

The puncture is performed on an outpatient basis. Carrying out at home is strictly prohibited due to the lack of resuscitation capabilities in the event of an unsuccessful puncture.

Before the puncture, no additional preparation of the patient is required, except for psychological, since the very fact of a deep puncture in the spine is quite difficult for emotional perception.

There is a certain procedure for the procedure.

• The patient is placed in a "lying" or "sitting" position.
• Regardless of the position the back should be maximally bent, which is ensured by tightly pressing both knees to the stomach and clasping them with your hands. This position contributes to the organization of the largest possible space for the advancement of the needle, eliminating the risk of it being clamped by the vertebral bodies.
• The point of insertion of the needle is the intervertebral space between the third and fourth or second and third lumbar vertebrae - the place where the length of the spinal cord ends and an extension for the ponytail is formed. This puncture site is typical for adults, and for children, due to the insufficient length of the spinal column, the puncture is performed under the third lumbar vertebra.
• General anesthesia is not required. Often use 1-2% novocaine solution for the purpose of local anesthesia, when the drug is injected in layers, approximately every 1-2 mm of the needle insertion depth, squeezing out a small amount of the solution.
• Beer Needle resembles a classic injection needle, but much larger in length and diameter of the inner hole. The needle is inserted strictly along the midline of the spinal column between the spinous processes of these vertebrae until it feels like a dip at a depth of about 4-7 cm in adults and 2 cm in children, which causes penetration into the subarachnoid space.
• The cerebrospinal fluid is under pressure, which is additionally provided by the position of the back during the puncture, so the use of suction manipulations is not required.
• Before and after the puncture, its place is treated with antiseptic agents, and upon completion it is sealed with a sterile adhesive plaster.
• The patient is asked to lie on their stomach and try to remain as static as possible for 2 hours., which will ensure an even distribution of cerebrospinal fluid instead of the taken one. With the introduction of drugs, the state of rest will ensure synchronization of pressure in the subarachnoid space throughout its cavity, as well as a uniform effect of the drug, which reduces the level of side effects after puncture.

Possible consequences and complications of the procedure

Given such an active interference in the functionality of the CSF, the spinal cord, as well as its direct anatomical and physiological contact with the brain, lumbar puncture can give a significant number of side effects and complications.

Very strong pain effect in the lumbar region, accompanied by nausea- a fairly common occurrence after puncture, which is explained specific effects of analgesics that have entered the cerebrospinal fluid and directly affect the neurons of the spinal cord and brain. Intravenous administration of caffeine often helps to suppress this side effect, but the drug is used in the absence of contraindications to it, which are quite a lot.

Contact of the needle with the root of the spinal nerve often causes sensation of loss of motor functions of the lower extremities and rather strong pain sensations about which the patient must be warned in advance. This phenomenon is temporary and, provided there is no damage to the roots, does not cause harm.

Headache- a constant companion of the patient after a lumbar puncture for 5-7 subsequent days. This effect is caused by a decrease or increase in the level of intracranial pressure due to corresponding changes in the volume of cerebrospinal fluid.

Headache can accompany the patient for a much longer period and are characterized as painful if the puncture was performed in a sitting position. The reason for the phenomenon lies in the excessive release of cerebrospinal fluid through the puncture channel into the ligamentous tissues or under the skin. The puncture channel remains open for quite a long time, since the cerebrospinal fluid, which has stuck into its lumen, does not contain thickening elements that contribute to clogging the hole. In some cases, experienced specialists, after receiving the required amount of CSF, during the withdrawal of the needle, inject small amounts of fresh patient blood taken from a vein in advance. This method allows you to organize a blockage of the canal, but it is somewhat dangerous, because blood clots should not get into the subarachnoid space.

A lumbar puncture, or lumbar puncture, is often used in neurology.

There are many diseases in which the final diagnosis is made only after a lumbar puncture and analysis of the material obtained (liquor).

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The site provides background information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious physician. All drugs have contraindications. You need to consult a specialist, as well as a detailed study of the instructions! .

Different etiologies of meningitis, encephalitis, hemorrhage in the subarachnoid space require a lumbar puncture. The study is effective for confirming multiple sclerosis, polyneuropathies (peripheral nerve damage) and neuroleukemia (blood cancer).

Lumbar puncture - indications for research

• CSF sampling (cerebrospinal fluid) for laboratory research.
• Carrying out more sparing spinal anesthesia before surgical interventions.
• Anesthesia of difficult childbirth in order to prevent pain shock.
• To measure the pressure of the cerebrospinal fluid.
• Performing in-depth studies: cisternography and myelography.
• The introduction of the necessary drugs.

Preparing the patient for manipulation

The medical staff will explain the rules for the upcoming manipulation. He will acquaint you with all the possible risks during the puncture and subsequent complications.
Preparation for a puncture includes the following steps:

1. The patient makes a written consent to the puncture.
2. A preliminary laboratory examination (blood sampling) is performed to assess the quality of the work of the kidneys, liver, coagulation system.
3. Medical history is collected. Recently transferred and chronic processes are monitored.
4. Be sure to inform the doctor about existing allergic reactions - to novocaine, lidocaine, iodine, alcohol, drugs used during anesthesia, contrast agents.
5. It is forbidden to take drugs for blood thinning (aspirin, lospirin, heparin, warfarin, aspekard, etc.). And non-steroidal anti-inflammatory and pain-relieving drugs.
6. The last meal is no later than twelve hours before the planned manipulation.
7. Women should even report a suspected pregnancy, because during the procedure, an X-ray examination may be necessary, and this is bad for the development of the fetus at any time.
8. Morning medication is strictly according to the doctor's recommendation.
9. The presence of relatives.

If this study is carried out on a child, the presence of the mother or father is allowed, but it is necessary to agree with the doctor in advance.

Lumbar Puncture Technique

1. The back area is treated with antiseptic soap.
2. Disinfection with iodine or alcohol.
3. A sterile dressing is applied around the surgical field.
4. Treatment of the puncture site with an antiseptic.
5. The patient is placed on a pre-disinfected couch in the “embryo” position. The legs bent at the knees are pressed to the stomach, and the head to the chest.
6. The surgical field is treated with an alcoholic solution of iodine.
7. Novocaine is injected subcutaneously for local anesthesia of the punctured area.
8. The needle is inserted between the third and fourth or fourth and fifth spinous processes of the spinal column.
9. If the procedure is performed correctly, both participants and the doctor and patient will feel the effect of "falling through" the needle, as a result of its passage into the dura mater.
10. The cerebrospinal fluid begins to flow out after the mandrin is removed. If there are no deviations, the cerebrospinal fluid is transparent and is released in drops.
11. Pressure is measured with a special manometer.
12. After completion of all planned manipulations, the needle is removed, the place of its entry is sealed with a sterile patch. In total, the process takes about forty-five minutes.
13. Strict bed rest for eighteen hours.
14. The doctor recommends painkillers to eliminate the consequences of the puncture (headache and soreness at the needle entry site).

The patient will be able to lead the same way of life only after the permission of the attending doctor.

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Contraindications to the diagnostic procedure

Harmless examinations have contraindications.

Puncture prohibited:

• With the dislocation of the brain, even if the diagnosis is not confirmed, but suspected. If the CSF pressure is reduced in some areas and increased in others, there is no way to exclude the phenomenon of wedging, which will inevitably lead to the death of the patient. In the history of medicine, there was a fatal case right on the table, during a diagnostic puncture.
• If infectious foci are detected at the puncture site on the skin or soft tissues. The risk of infection in the spinal canal is high.

Do the procedure with caution if:

• The patient is sick with thrombocytopenia.
• There are deviations in the blood coagulation system (high risk of bleeding). Preparation is necessary: ​​the abolition of thinning agents, platelet mass, frozen plasma. Recommendations will be given by the doctor after performing the necessary examinations.

Deciphering the results of the study of cerebrospinal fluid

Normally, cerebrospinal fluid resembles distilled water, the same colorless and transparent.

But with various diseases, its color and consistency change, which indicates the presence of a malfunction in the body.

For example:

1. A greenish tint, characteristic of purulent meningitis or brain abscess.
2. After injuries or hemorrhages, its color turns red, due to the presence of erythrocytes (red blood cells).
3. Gray or gray-green cerebrospinal fluid comes from a large number of microorganisms and white blood cells that are trying to cope with the infection.
4. Brown color is rare, it is the result of rupture of the cyst in the path of passage of the CSF.
5. Yellow or yellow-brown color appears as a result of the breakdown of hemoglobin or the use of drug groups.
6. Immature or mutilated, cancer cells indicate malignant oncological processes.

What are the consequences of puncture

• One of the most common side effects of this procedure is headache.

  It starts between twelve and 20 four hours after the completion of the procedure.

  Its duration is from a couple of days to fourteen days. Pain tends to decrease in intensity in the horizontal position of the body and increase in the vertical position.

• Bleeding is especially common when taking anticoagulants.
• Various types of hematoma.
• Needle injury to the intervertebral disc or nerve roots.
• When skin particles get into the cerebrospinal fluid, tumors of the spinal canal are formed.
• The introduction of drugs, contrast, antibacterial agents into the spinal space leads to a change in the composition of the cerebrospinal fluid. Perhaps the development of myelitis, arachnoiditis or sciatica.
• Miscarriages are common in the first trimester of pregnancy.

The risks and benefits of performing a lumbar puncture are carefully studied and decided after all possible research has been done.

Specifically, taking into account the clinical manifestations of each patient. The final decision is up to the patient or his relatives. In the days of MRI and CT, this manipulation began to be resorted to less frequently. But for some diseases, it is indispensable.

Spinal Puncture Needles

Different needles are used for puncture. They have different tip sharpness and cut shape. Due to the choice of optimal parameters for a particular procedure, the holes in the dura mater are made neat, which avoids a number of complications.

The most common types of needles:

1. The most common type of spinal needles is Quincke. They have a particularly sharp edge. She carefully makes a hole thanks to the beveled tip.
2. Whitacre and Green needles have a distal tip shape. This allows you to push the fibers of the dura mater. The cerebrospinal fluid flows out through a hole of a much smaller diameter.
3. Spratte needles are used during puncture, but less frequently compared to other types. They have a conical tip and a large side opening. They are often used for pain relief during childbirth.

For the production of puncture needles in the European Union, stainless steel is used. The material is good in that during the procedure, the risk of breakage or bending of the needle is reduced. If the patient is overweight, then he will need an extra long needle for the procedure. In terms of strength, it does not differ from all other types.

When suspected of what diseases, a puncture is performed

This procedure is carried out for both diagnostic and therapeutic purposes.

A lumbar puncture is done for diagnosis in the following situations:

• For measuring cerebrospinal fluid pressure;
• To study the subarachnoid space of the spinal cord;
• To determine if an infection is present in it;
• To study the cerebrospinal fluid.

For medicinal purposes, the procedure is carried out in the following situations:

• To remove excess CSF that has accumulated in the cerebrospinal fluid;
• To withdraw funds left after chemotherapy or antibacterial drugs.

Indications are divided into 2 types:

1. Absolute.
2. Relative.

In the first case, the procedure is carried out based on the patient's condition. In the second case, the final decision on the appropriateness of this procedure is made by the doctor.

The procedure is performed when the patient:

• Various infectious diseases;
• Hemorrhage;
• Malignant neoplasms.

The first type of indications include finding out the reasons for the outflow of cerebrospinal fluid, for which dyes or radiopaque substances are injected.

Relative indications include:

• Polyneuropathy of an inflammatory nature;
• Fever of unknown origin;
• Demyelinating diseases, such as multiple sclerosis;
• Systemic connective tissue diseases, such as lupus erythematosus.

The cost of a spinal tap

The price of the procedure depends on:

The complexity of the study;
• The nature of the puncture.

In Moscow clinics, the price is from 1420 rubles to 5400.

There are special instructions and requirements not only for the procedure. As the puncture is carried out, doctors advise to follow special instructions.

3 tips for a patient who has undergone this procedure:

1. Be sure to observe bed rest. This will minimize the likelihood of CSF leakage through the puncture hole.
2. To be in a horizontal position for about 3 hours after the puncture has ended, to alleviate the patient's condition if he has some pain.
3. It is strictly forbidden to lift heavy objects in order to prevent the development of complications after the procedure.

If you follow the described rules, then complications will not arise. In case of even the slightest discomfort, you should immediately consult a doctor.

3 tips for caring for a patient who has had a puncture:

1. As the procedure is completed, the patient is prescribed bed rest for 5 days. The time can be reduced to 3 days if drugs were injected into the subarachnoid region.
2. Provide the patient with a horizontal position and put on the stomach. Create a calm and quiet environment for him.
3. Make sure he drinks plenty of liquids at room temperature.

If necessary, give him an intravenous plasma substitute. Before doing this, consult with your doctor about the appropriateness.

Urgent consultation with a doctor will be required if the patient has at least one of the symptoms described below:

• Chills;
• Numbness;
• Fever;
• Feeling of tightness in the neck;
• Discharge from the puncture site.

General opinion of those who underwent a spinal tap

There are patients who, for health reasons, had to undergo more than one such operation. They testify that it is nothing terrible. But they note that the most important thing when performing a puncture is to get to a good specialist. They are sure that if the needle is inserted incorrectly, you can remain disabled for life.

Patients who underwent the procedure several times note that no side effects were observed. Sometimes there were minor headaches, but this happened rarely. If you want to completely eliminate the occurrence of pain during the puncture, they advise asking the doctor to use a smaller diameter needle. In these situations, you do not feel pain, the likelihood of complications is reduced.

Some patients compare the procedure to an intragluteal injection because the sensations are similar. There is nothing wrong with the procedure itself. For many, the preparation process itself is more exciting.

A month after the procedure, patients feel great. This condition is observed if everything went correctly. They do not notice any special sensations, except for those that are characteristic of an ordinary injection. Sometimes patients observed an unexpected sensation for them, similar to a blow, which was concentrated in the knee area. After the procedure was completed, it completely disappeared. Some patients say that there was a feeling that everything was not happening to them. After the end of the procedure, anesthesia was evenly released from top to bottom.