Lumbar puncture - indications and how the analysis is performed. Spinal puncture: algorithm and technique. Indications, consequences, complications Where can a spinal cord puncture be taken?

Spinal tap, or lumbar, is often used in neurology.

There are many diseases for which the final diagnosis is made only after a lumbar puncture and analysis of the resulting material (cerebrospinal fluid).

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The site provides background information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor. Any drugs have contraindications. Consultation with a specialist is required, as well as detailed study of the instructions! .

Meningitis, encephalitis, hemorrhages in the subarachnoid space of various etiologies require lumbar puncture. The study is effective in confirming multiple sclerosis, polyneuropathies (damage peripheral nerves) and neuroleukemia (blood cancer).

Lumbar puncture - indications for research

• Collection of cerebrospinal fluid (cerebrospinal fluid) for laboratory research.
• Conducting a more gentle spinal anesthesia before surgical interventions.
• Pain relief during difficult labor to prevent painful shock.
• To measure cerebrospinal fluid pressure.
• Performing in-depth studies: cisternography and myelography.
• Administration of necessary medications.

Preparing the patient for manipulation

Medical staff will explain the rules for the upcoming manipulation. Introduces everyone possible risks during the puncture and subsequent complications.
Preparation for puncture includes the following steps:

1. The patient provides written consent for the puncture.
2. Preliminary laboratory examination(blood sampling) to assess the quality of the kidneys, liver, and coagulation system.
3. An anamnesis of the disease is collected. Recent and chronic processes are monitored.
4. Be sure to tell your doctor about any existing allergic reactions- for novocaine, lidocaine, iodine, alcohol, drugs used during anesthesia, contrast agents.
5. It is prohibited to take blood thinners (aspirin, lospirin, heparin, warfarin, aspecard, etc.). And non-steroidal anti-inflammatory and pain-relieving drugs.
6. Last meal no later than twelve hours before the planned manipulation.
7. Women should report even suspected pregnancy, because during the procedure there may be a need for x-ray examination, and this is bad for the development of the fetus at any time.
8. Take medications in the morning strictly as recommended by the doctor.
9. Presence of relatives.

If this study is performed on a child, the presence of the mother or father is allowed, but an agreement must be made with the doctor in advance.

Lumbar puncture technique

1. The back area is treated with antiseptic soap.
2. Disinfection with iodine or alcohol.
3. Around surgical field a sterile napkin is applied.
4. Treating the puncture site with an antiseptic.
5. The patient is placed on a previously disinfected couch in the “embryo” position. Legs bent at the knees are pressed to the stomach, and the head is pressed to the chest.
6. The surgical field is processed using alcohol solution Yoda.
7. Novocaine is injected subcutaneously to local anesthesia 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, the doctor and the patient, will feel the effect of the needle “falling through” as a result of its passage into the dura mater.
10. Cerebrospinal fluid begins to leak after the mandrin is removed. If there are no deviations, the cerebrospinal fluid is clear and comes out in drops.
11. A special pressure gauge measures pressure.
12. After completing all planned manipulations, the needle is removed and its entry point is sealed with a sterile pad. 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 pain at the point where the needle enters).

The patient will be able to lead his previous lifestyle only after the permission of the treating doctor.

Video

Contraindications to the diagnostic procedure

There are contraindications for harmless examinations.

Puncture is prohibited:

• In case of brain dislocation, even if the diagnosis is not confirmed, but suspected. If the cerebrospinal fluid pressure is reduced in some areas and increased in others, it is not possible to exclude the phenomenon of herniation, 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 at the puncture site there is skin or soft tissues infectious foci were identified. The risk of infection in the spinal canal is high.

The procedure is done with caution if:

• The patient is ill with thrombocytopenia.
• There are abnormalities in the blood coagulation system ( high risk bleeding). Preparation is necessary: ​​abolition of thinning agents, platelet mass, frozen plasma. The doctor will give recommendations after performing the necessary examinations.

Interpretation of the results of the study of cerebrospinal fluid

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

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

Eg:

1. Greenish tint, characteristic of purulent meningitis or brain abscess.
2. After injury or hemorrhage, its color turns red due to the presence of erythrocytes (red blood cells).
3. Gray or gray-green liquor comes from large quantity microorganisms and leukocytes that try to cope with the infection.
4. Brown color is rare and is the result of a ruptured cyst in the cerebrospinal fluid pathway.
5. The yellow or yellow-brown color appears as a result of the breakdown of hemoglobin or the use of medicinal groups.
6. Not mature or deformed, cancer cells indicate malignant oncological processes.

What are the consequences of puncture?

• One of the most common consequences resulting from this procedure is headache.

  Begins between twelve and 20 four hours from the moment the procedure is completed.

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

• Bleeding occurs especially often when taking anticoagulants.
• Various types of hematoma.
• Needle injury intervertebral disc or nerve roots.
• When skin particles enter the cerebrospinal fluid, tumors of the spinal canal are formed.
• Introduction into the spinal space of drugs, contrast, antibacterial agents, entails a change in the composition of the cerebrospinal fluid. Myelitis, arachnoiditis or radiculitis may develop.
• Miscarriages are common in the first trimester of pregnancy.

The risks and benefits of performing a lumbar puncture are carefully considered and decided after all possible studies have been performed.

Specifically taking into account clinical manifestations for every patient. The final decision rests with the patient or his relatives. In the days of MRI and CT, this manipulation began to be used 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. By choosing the optimal parameters for a specific procedure, the holes in the dura mater are made neat, which helps to avoid a number of complications.

The most common types of needles:

1. The most common type of spinal needle is Quincke. They have a particularly sharp edge. It is used to carefully make a hole thanks to the beveled tip.
2. In the needles of Whitacre and Green distal form tips. This allows the fibers of the hard material to move apart meninges. The liquor flows through a hole of much smaller diameter.
3. Sprott needles are used for puncture, but less frequently compared to other types. They have a conical tip and a large side opening. They are more often used for pain relief during childbirth.

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

If a disease is suspected, a puncture is performed

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

A spinal tap is performed for diagnosis in the following situations:

• To measure liquor pressure;
• To study the subarachnoid space of the spinal cord;
• To determine whether an infection is present in it;
• For studying cerebrospinal fluid.

IN medicinal purposes the procedure is carried out in the following situations:

• To remove excess cerebrospinal fluid that has accumulated in the cerebrospinal fluid;
• To withdraw funds remaining 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 advisability 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 indication includes finding out the reasons for the leakage of cerebrospinal fluid, for which dyes or radiopaque substances are administered.

TO relative indications include:

• Inflammatory polyneuropathy;
• Fever of unknown origin;
• Demyelinating diseases, such as multiple sclerosis;
• Systemic diseases connective tissue, for example lupus erythematosus.

Cost of a spinal tap

The price of the procedure depends on:

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

In Moscow clinics the price ranges from 1,420 rubles to 5,400.

Not only there are special instructions and requirements for the procedure. After the puncture is performed, doctors advise following 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 cerebrospinal fluid leaking through the puncture hole.
2. Stay in a horizontal position for about 3 hours after the puncture is completed to alleviate the patient’s condition if he experiences 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, there will be no complications. In case of even the slightest discomfort, you should immediately consult a doctor.

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

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

If necessary, administer a plasma substitute intravenously. Before doing this, consult your doctor about the advisability.

An urgent consultation with a doctor will be required if the patient experiences at least one of the symptoms described below:

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

General opinion of those who have had a spinal tap

There are patients who, for health reasons, had to undergo more than one such operation. They testify that she 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 puncture, they advise asking the doctor to use a needle of a smaller diameter. In these situations, you do not feel pain, and the likelihood of developing complications is reduced.

Some patients compare the procedure to an intragluteal injection because the sensation is similar. There is nothing scary about 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, other than those that are characteristic of a regular injection. Sometimes patients observed an unexpected sensation, similar to a blow, which was concentrated in the knee area. After completing the procedure, this completely disappeared. Some patients say that there was a feeling that everything was not happening to them. After the procedure was completed, the anesthesia was released evenly from top to bottom.

Spinal cord puncture involves inserting a needle under the arachnoid membrane of the spinal cord to carry out therapeutic or diagnostic measures. In terms of diagnostics, this is an important stage that can recognize such a serious disease as a stroke, especially if blood has entered the subarachnoid space of the brain or spinal cord.

Why is it worth doing this?

First of all, spinal cord puncture is performed as an important stage in the diagnosis of hemorrhages or inflammatory processes. This produces a liquid called cerebrospinal fluid. It is this that allows you to obtain a large amount of useful information. It is examined for the content of cells and microorganisms, as well as for transparency. During treatment, a puncture can remove excess cerebrospinal fluid, thereby reducing intracranial pressure and pressure in the spinal canal, as well as administering medications.

It's not at all simple

A spinal tap, or lumbar puncture, is performed with the patient lying down or sitting in a chair. In the latter version, this manipulation is almost not performed at the moment. A more preferable position is when the patient lies on one side with the head tilted to the chest and legs brought to the stomach. The end of the spinal cord in an adult is located at the level of 1-2 lumbar vertebrae. But the membranes pass lower, and this position allows you not to damage the spinal cord during the puncture. The needle is inserted into the space between the third and fourth lumbar vertebrae. A landmark can be the Jacobi line, which connects the spinous process of the fourth lumbar vertebra and the iliac crests. The puncture in children should be done a little lower, at the level of the 4-5 lumbar vertebrae.

Preparation

Before a spinal cord puncture is performed, it is worth treating the puncture site and numbing it. The puncture is performed using a special needle with a guide and is made parallel to the spinous processes, at a slight angle. The correct placement of the needle is indicated by a feeling of “failure”, after which it is necessary to pull out the conductor and cerebrospinal fluid will begin to flow out of the needle. If there is no cerebrospinal fluid or the needle gets into the bone, it is worth repeating the manipulation from the beginning. After the puncture, the puncture site should be covered with a sterile napkin.

After the puncture

After the manipulation is completed, you should adhere to certain rules. You need to lie in bed for 2-3 hours, this will help prevent further leakage of cerebrospinal fluid. If you immediately get out of bed after a spinal puncture has been performed, you may lose consciousness; the body must first adapt.

Anything can happen

Listed below are some of the problems that a spinal tap can cause. The consequences can be very different, it is important to remember them and avoid mistakes. Although the percentage of complications is only from 0.5 to 1%, it is important to constantly monitor your actions and the patient’s condition. The development of axial herniation is possible, and along with the needle, an infection can get under the arachnoid membrane. The latter complication is also possible when performing another, no less important manipulation, such as a bone marrow puncture, the consequences of which can be quite unpleasant. During a puncture, there is a possibility of damage to the spinal cord roots, as well as intervertebral discs, at the site of damage a hernia may appear. But this is in rare cases, which, if the manipulation is carried out correctly, will not occur at all.

Shoshina Vera Nikolaevna

Therapist, education: Northern Medical University. Work experience 10 years.

Articles written

For many, brain puncture is subconsciously considered dangerous, but in fact it is not. If performed by an experienced doctor, it is absolutely safe. It is thanks to it that it is possible to detect ulcers in brain tissue, determine the contents of neoplasms and the state of other pathologies.

But there are also a number of dangers that can be encountered with this procedure. Let's figure it out.

The puncture is performed with a special needle, which, penetrating the brain tissue, can draw fluid from it. To make a puncture safe, you need to follow a number of rules:

1. The area of ​​the head where the puncture will be made must be thoroughly disinfected. First, it is treated with hydrogen peroxide, and then generously lubricated with iodine.
2. For the procedure, you cannot use a regular needle, only a special puncture needle with a blunt end. It is produced quite wide and equipped with a mandrel.
3. There should be 2 needles, one of which will be a spare if the first one is blocked by brain tissue.
4. The puncture should be made to a depth of no more than 4 cm. This is the only way to ensure the safety of the fence and prevent the penetration of purulent secretions into.
5. Before the procedure, the patient must have a bowel movement.
6. The patient must be completely immobile, so he can be fixed with special devices.

Areas of application, indications, contraindications

Such a study is carried out in areas where there is suspicion of pus formation, most often these are:

• lower part of the frontal lobe;
• inferior part of the temporal lobe;
• tympanic space;
• near the mastoid process.

A puncture is taken to diagnose brain pathologies, such as:

• infectious lesion of the central nervous system;
• inflammatory process in the central nervous system;
• bacterial, viral, fungal diseases;
• infection of brain tissue with tuberculosis or syphilis;
• bleeding;
• multiple sclerosis;
• neoplasms of any type;
• neuralgic pathologies;
• swelling of brain tissue;
• problems with the vascular system.

Important! Before the procedure, the patient must indicate in a special questionnaire a list of the medications he is currently taking, whether he is allergic to anesthetics or medications, and whether he has problems with blood clotting.

The procedure is prohibited if:

• the patient is at any stage of pregnancy;
• he is in a state of traumatic shock;
• lost a lot of blood;
• there are intracranial hematomas;
• brain abscess diagnosed;
• abundant;
• diagnosed with hypertension;
• there are abundant infectious and purulent lesions on the back;
• there are lumbar bedsores;
• the brain is injured.

How to carry out the procedure

Why the procedure is being done has been determined, now you need to understand the methods for carrying it out. They are different and directly depend on the area where the liquid is taken.

Anterior horn of the lateral ventricle

The ventricular procedure for this area is performed as follows:

1. The patient lies on his back when a tumor in the brain is to be identified. Usually the patient lies down on the healthy side to make it more convenient for the doctor to perform a puncture on the injured side.
2. The head is slightly tilted towards the chest.
3. The puncture site is thoroughly disinfected and coated with iodine twice.
4. Draw a puncture line, which should be guided by the arrow-shaped seam, passing the Kocher point. It is covered with a layer of brilliant green solution.
5. The head is covered with a sterile sheet.
6. Any local anesthetic to which the patient is not allergic is used to numb the puncture area, most often it is Novocaine.
7. Using a scalpel, an incision is made along the intended line.
8. A cut is made on the trepanation window on the exposed skull.
9. The neurosurgeon makes a cross-shaped incision on the dura mater. Wax is rubbed in or electrocoagulation is performed. For what? To stop bleeding, the latter method being the most effective.
10. The cannula is inserted into the brain tissue to a depth of no more than 5-6 cm so that it runs parallel to the incision line. When puncturing the wall of the lateral ventricle, the doctor will feel a slight dip.
11. Yellowish cerebrospinal fluid will begin to flow through the submerged cannula. Having penetrated the cavity of the ventricle, the doctor fixes the needle and, using a mandrel, regulates the volume and speed of the withdrawn fluid.

Often there is high pressure in the ventricular cavity, and if it is not controlled, the fluid will flow out in a stream. This will lead to the patient developing neuralgic problems.

The permissible volume of fluid intake is in the range of 3-5 ml. It is important to note that in parallel with the preparation of the room for the puncture, the operating room is also prepared, since there is a high risk that air may enter the area being examined, or the depth of the puncture will be excessive, which may cause injury to the blood vessel. In these cases, the patient will be urgently operated on.

In cases of puncture, children use the methods of collecting cerebrospinal fluid according to Dogliotti and Geimanovich:

1. In the first case, the puncture is carried out through the orbit.
2. In the second - through the lower part of the temporal bone.

Both of these options have a significant difference from the traditional procedure - they can be repeated as often as needed. For infants, this procedure is carried out through an open fontanel, simply by cutting the skin above it. In this case, there is a serious danger that the baby will develop a fistula.

Posterior horn of the brain

The technology for collecting cerebrospinal fluid from the area is carried out in the following order:

1. The patient lies on his stomach. His head is tightly fixed so that the sagittal suture is strictly in the middle cavity.
2. The preparatory process is identical to the above procedure.
3. The incision of the skull tissue is carried out parallel to the sagittal suture, but so that it passes through the Dandy point, which should be strictly in its middle.
4. Take a needle number 18, which is used strictly for this type of puncture.
5. It is inserted at an angle, directing the needle tip into the outer upper edge of the orbit to a depth of no more than 7 cm. If the procedure is performed on a child, the puncture depth should not exceed 3 cm.

inferior horn of the brain

The principle of the procedure is similar to the previous two:

• the patient should lie on his side, since the surgical field will be the side of the head and the auricle;
• the incision line will go 3.5 cm from the external auditory canal and 3 cm above it;
• part of the bone in this area will be removed;
• an incision will be made in the dura mater of the brain;
• insert a puncture needle 4 cm, directing it to the top of the auricle;
• cerebrospinal fluid will be collected.

Clinical picture after the procedure

Of course, the symptoms after puncture sampling are different for everyone, but they can be combined into a general clinical picture:

1. Pain in the head area of ​​varying intensity and duration.
2. Prolonged nausea and vomiting.
3. Convulsions and fainting.
4. Malfunction of the cardiovascular system.
5. Impaired respiratory function; in rare cases, the patient may need artificial ventilation.
6. Neuralgic problems.

Whether the patient will have the above symptoms directly depends on the experience of the neurosurgeon and his skills. The procedure must be performed strictly according to medical instructions, which can guarantee the absence of complications after the puncture.

It is important not only to correctly fix the patient, but also to accurately determine the puncture area. Treatment of the affected area is important both at the stage of preparation for the procedure and after it. Upon completion of the collection, be sure to apply a sterile bandage.

It is important that the patient does not feel any discomfort, much less pain, at the time of the puncture.

Due to the fact that the procedure is most often prescribed for diagnosing pathologies, it, like any other diagnostic measure, should be painless. The patient will be conscious at all times, so he should immediately inform the doctor about any discomfort that has arisen. This will help avoid a number of complications. The doctor will change the technology or completely interrupt the procedure.

Puncture is an important procedure in medicine, and taking cerebrospinal fluid from the brain even more so. Before undergoing it, the patient will undergo a series of studies that will help identify possible contraindications. There is no need to worry; brain puncture is performed only by experienced specialists who know their job.

To examine the patient, specialists use various diagnostic methods. One of them is spinal cord puncture, otherwise called lumbar puncture.

This is a serious and rather complex process in which spinal cord fluid is taken. This procedure has some risks, and therefore it is used relatively rarely.

What is the procedure

Cerebrospinal fluid is collected in order to confirm the suspected diagnosis or to identify associated complications. We propose to consider the most common situations requiring this procedure:

• infectious diseases of various types;
• inflammatory processes occurring in the spinal cord or brain;
• subarachnoid bleeding;
• the presence of bone tissue compactions;
• determination of spinal cord fluid pressure;
• suspected tumor.

Why else is a spinal puncture done? In addition to the situations that we have listed, the procedure can be performed for medicinal purposes. For example, thanks to puncture, it is possible to administer medications and thus relieve the patient.

A patient after a stroke may also undergo a spinal puncture. This will help clarify the nature of the stroke.

However, before puncturing, the patient will be informed about the risk of the procedure, so it will be performed only in the most extreme cases.

Technique

We have looked at why a puncture is taken from a vertebra; now we suggest finding out exactly how this procedure is carried out:

Before performing the procedure, the doctor first palpates the puncture site, feeling the required vertebrae and the distance between them. The intended puncture site is treated with a three percent iodine solution and a 70% ethyl alcohol solution. These products are applied from the center to the periphery.

As for pain relief, 4 to 6 milliliters of a two percent solution of novocaine or another anesthetic, which is administered during the future puncture, is sufficient. It is worth noting that many doctors prefer lidocaine to collect spinal cord fluid.

Local anesthesia is also given to patients with impaired consciousness. This is due to the fact that mild pain can provoke an unwanted motor reaction.

Before carrying out the procedure, the specialist must check the site of the intended puncture several times and also make sure that the needle is in good working order. The course of the needle during puncture of the intervertebral disc should resemble the position of a pen when writing.

For young children, the direction of the needle is perpendicular to the plane being punctured. As for adults, the needle is inserted with a slight inclination, taking into account the overhang of the spinous vertebrae.

Possible complications

Any interference with the natural functioning of the body entails certain risks and can lead to various complications. Some patients complain that their spine hurts after the puncture. Patients often report the following symptoms:

• nausea;
• headache;
• dizziness;
• vomit;
• general weakness.

Some experts are inclined to believe that two to three hours in a prone position is quite enough and after this time the patient can move freely. This will significantly reduce the risk of developing undesirable consequences.

It is also worth noting that some patients may experience severe pain. In such cases, the doctor will prescribe an effective pain reliever.

Another complication may be infection during the collection of spinal cord fluid. But if the procedure is carried out under sterile conditions, then the risk of infection is practically absent.

Doctors often encounter patients' fears that the spinal cord will be affected during the collection of cerebrospinal fluid. We hasten to dispel these misconceptions. The puncture is taken in the lumbar spine, just below the spinal cord itself. In this regard, it is not possible to touch him.

To be fair, it is worth saying that today there are much less dangerous diagnostic methods than spinal puncture.

Therefore, if possible, doctors will use CT, MRI or ultrasound. But, unfortunately, there are diagnoses that only require a puncture to confirm. In this case, strictly follow all doctor’s recommendations and stay healthy!

Denial of responsibility

The information in the articles is for general information purposes only and should not be used for self-diagnosis of health problems or for therapeutic purposes. This article is not a substitute for medical advice from a doctor (neurologist, therapist). Please consult your doctor first to know the exact cause of your health problem.

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

This procedure is often called a lumbar puncture or lumbar puncture.

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

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

Spinal tap

About the puncture technique

There is a puncture technique that must not be violated and is a gross mistake by the surgeon. Correctly, such an event should be called a puncture of the subarachnoid space, or more simply, a spinal puncture.

The cerebrospinal fluid is located under the meninges, in the ventricular system. This way the nerve fibers are nourished and the brain is protected.

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

The lumbar region is pierced not only for medicinal purposes to administer medication, but also to diagnose or confirm the suspected diagnosis. It is also a popular method of anesthesia for surgery on the peritoneal and pelvic organs.

It is imperative to study the indications and contraindications when deciding on a spinal cord puncture. This clear list must not be ignored, otherwise patient safety will be compromised. Of course, such an intervention is not prescribed by a doctor without a reason.

Who can undergo puncture?

Indications for such manipulation are as follows:

• suspected infection of the brain and its membranes - these are diseases such as syphilis, meningitis, encephalitis and others;
• diagnostic measures for the formation of hemorrhages and the appearance of formations. Used for informational impotence of CT and MRI;
• the task is to determine liquor pressure;
• coma and other disorders of consciousness;
• when it is necessary to administer 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 are tumors, neuroinfections, hemorrhages, hydrocephalus.

Sclerosis, lupus, an incomprehensible increase in temperature are not required to be examined 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 type of treatment is required and to determine the sensitivity of microbes to antibiotics.

Puncture is also used to remove excess fluid in case of 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 make it possible to have an active effect on tumor cells without an elephant dose of drugs.

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

Important! Before performing a puncture, it is imperative to exclude possible pathologies, contraindications and risks. Neglecting this can lead to the death of the patient.

When a spinal tap cannot be performed

Sometimes carrying out this treatment diagnostic procedure may cause more harm and may even be life-threatening.

Main contraindications for which puncture is not performed:

Puncture procedure

How do you prepare for the procedure?

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

1. blood and urine tests;
2. diagnostics of blood properties, in particular coagulation indicators;

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

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

Before an x-ray with contrast, women should make sure that there is no pregnancy at the time of puncture. Otherwise, the procedure may negatively affect the fetus.

If the puncture is performed on an outpatient basis

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

If you come and go on your own, you should think about returning home. After the puncture, dizziness and weakness are possible; it would be good to get help from someone.

You should not consume food or liquid 12 hours before the procedure.

Puncture can be prescribed for children

The indications are similar in adults. However, the majority are infections and suspected malignancies.

The puncture is not performed without parents, especially when the baby is scared. A lot depends on the parents. They are obliged to explain to the child why the procedure is being performed, to report the pain, that it is tolerable, and to reassure.

As a rule, a spinal tap does not involve the administration of anesthesia. Local anesthetics are used. This is done to better tolerate the procedure. But, in case of an allergy to novocaine, you can completely refuse pain relief.

During a puncture, when there is a risk of cerebral edema, it makes sense to administer furosemide 30 minutes before inserting the needle.

The process of taking a puncture

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

1. Lying down. The person is placed on a hard table on his right side. In this case, the legs are pulled towards the stomach and clasped with the arms.
2. Sitting, for example, on a chair. It is important to bend your back as much as possible in this position. 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 spinal tissue.

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

Stages

The puncture procedure consists of several stages:

Preparation

Medical personnel prepare 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 required 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.

Pain relief 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 location with the cut up at an angle of 90 degrees relative to the skin. Then, with a slight tilt towards the head of the person being examined, the needle is very slowly inserted deep into the area.

Along the way, the doctor will feel three needle dips:

1. skin puncture;
2. intervertebral ligaments;
3. membrane of the spinal cord.

After passing through all the gaps, the needle has reached the intrathecal space, which means the mandrel should be removed.

If no cerebrospinal fluid appears, 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 spinal cord canal, a special device - a manometer - determines the cerebrospinal fluid pressure. An experienced doctor can determine the indicator visually - up to 60 drops per minute is considered normal.

The puncture is taken in 2 containers - one sterile in an amount of 2 ml, necessary for bacteriological research, and the second for cerebrospinal fluid, 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 doctor’s accuracy and correctness of actions influence the risk of complications.

In general, the amount of liquid obtained during puncture is no more than 120 ml. If the purpose of the procedure is diagnostics, then 3 ml is sufficient.

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

Important! Throughout the entire procedure, the patient is not allowed to move, so assistance from medical staff is required. If the puncture is performed on children, a parent helps.

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

When the needle touches a nerve root, the pain is sharp, as with radiculitis. But this happens rarely and even relates more to complications.

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

Recovery period

As soon as the needle is removed, the patient does not stand up, but remains in a supine position for at least 2 hours on his stomach without a pillow. Children under 1 year of age, on the contrary, are placed 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 to monitor the condition, because the cerebrospinal fluid can run out of the hole from the needle for up to 6 hours.

As soon as signs of swelling and dislocation of the brain parts appear, help is provided immediately

After the puncture procedure, you must remain in bed. You can get up after 2 days if your readings are normal. If unusual changes occur, the period may increase to 14 days.

Headaches may occur due to decreased fluid volume and decreased blood pressure. In this case, analgesics are prescribed.

Complications

A spinal tap always carries risks. They increase if the algorithm of actions is violated, there is not enough information about the patient, or in case of a serious health condition.

Possible but rare complications are:

If the procedure is carried out in compliance with all conditions, then almost no unwanted consequences appear.

Stage of studying cerebrospinal fluid

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

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

Normal color Cerebrospinal fluid is clear and colorless, without red blood cells. Protein is contained and should not exceed 330 mg per liter.

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

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

An important indicator is the density of cerebrospinal fluid, which changes during diseases. If there is inflammation, then it increases, if hydrocephalus, it decreases. If the pH level drops, then most likely the diagnosis is meningitis or encephalitis; if it increases, the diagnosis is brain damage from syphilis or epilepsy.

Dark liquid speaks of jaundice or melanoma metastasis.

Turbid cerebrospinal fluid is a bad sign, indicating leukocytosis of bacterial origin.

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