What is a puncture? It is a specific procedure used to diagnose diseases or treat internal organs and biological cavities. We will tell you more about this procedure and the features of its implementation. It is also worth mentioning the possible consequences of the puncture.
Basic Concepts
To carry out this procedure, special needles and other devices are used. Before you agree to have it performed, it is worth learning more about its features and what a puncture is in general.
This is a specific puncture of the tissues of internal organs, blood vessels, tumor formations or cavities, with the help of which the internal fluid is taken for analysis. This is done in order to diagnose any pathology. Sometimes medications are administered in the same way. This procedure is also used to diagnose diseases of the liver, bone marrow, and lungs. Spinal tap is very common.
To determine oncology
As a rule, this is how doctors identify cancer. To clarify the diagnosis, material is taken directly from the tumor. Blood vessels are punctured to collect fluid for laboratory tests or to install a catheter through which medications will be administered. Parenteral nutrition can be provided in the same way.
To remove liquid
If the abdominal, articular or pleural cavities are filled with fluid or pus, or if there is an inflammatory process, a puncture can be used to remove the fluid. Using this manipulation, you can install drainage for washing internal organs or administering medications. During surgery performed on the extremities, puncture is mandatory procedure in anesthesiology. This manipulation is widespread in gynecology for diagnostic and therapeutic purposes. For example, follicle puncture is performed during IVF.
Indications for use
In order to perform puncturing, appropriate indications are required. For example, in gynecology, puncture is used to confirm ectopic pregnancy, infertility due to female factor, determining the presence of uterine ruptures, excluding peritonitis, determining the amount and nature of exudate in the cavities of an organ or tumor.
Also, with the help of puncture, endometriosis, cysts, tumor formations are detected, and the presence of uterine bleeding of unknown etiology, developmental anomalies are diagnosed reproductive organs, collect material for laboratory research, and select eggs for IVF. After the procedure, the patient can be sent home the next day.
Not everyone knows what a puncture is.
Types of puncturing in gynecology
There are several types of punctures used for diagnostic and therapeutic purposes. Breast puncture is prescribed when nodules, ulcers, lumps appear, changes in skin tone, or discharge from the nipples. With the help of this manipulation, the presence of tumors is determined, and their nature is also diagnosed. Some preparation is required for such procedures. Seven days before taking the material, you should not take aspirin or other blood thinning medications.
Is there any discomfort?
After puncture, the patient may feel some discomfort, but these sensations disappear after a few days. In the case of egg retrieval for artificial insemination, the procedure is carried out one day after the injection of a certain drug.
How is a puncture taken? This is done transvaginal method using a special needle. IN in this case Throughout the entire process, the doctor monitors the procedure using an ultrasound machine. Carrying out these manipulations requires a certain skill from the doctor, so you need to contact an experienced specialist. Puncture of follicles during IVF is not considered painful, but in order to avoid complications, the patient is given anesthesia. In addition, a puncture is done to determine the presence or absence congenital pathology or an infectious disease in the fetus during pregnancy. To do this, blood is taken from the umbilical cord. The procedure can be performed starting from the sixteenth week, but, as a rule, doctors prescribe it only from 22-24 weeks to avoid complications.
A puncture needle is made through the abdomen into the umbilical cord vessel using a special sterile device. This technique is considered the most accurate in determining developmental anomalies or infectious pathologies, but is used only if other diagnostic methods are ineffective. A procedure such as puncture of an ovarian cyst is used for diagnostic or therapeutic purposes.
The manipulation is performed under general anesthesia, which is administered intravenously. The doctor inserts all instruments through the vagina. The needle is attached to a special sensor, and an aspirator is in turn attached to it. Using instruments, fluid is sucked out from the cyst cavity and then sent for cytology or histology. Next, after pumping out all the fluid from the cavity, a certain amount of alcohol is pumped in, which glues the walls of the cyst together.
Most often, such manipulations relieve the patient of the cyst, although sometimes relapses are still possible. In this case, this is completely painless, but the woman should not move, so the use of anesthesia is necessary.
Puncture of the abdominal cavity is carried out through the wall or through a puncture of the posterior vaginal vault. The procedure is used for diagnostic purposes, as well as in preparation for surgery. This type is very painful and is necessarily accompanied by anesthesia, which can be either local or general.
Preparation for the puncture is very important. Before the procedure, the intestines and bladder empty their bowels. All types of puncture indicated above are used in gynecological practice when other diagnostic or therapeutic methods do not produce results.
Other indications for puncture
To diagnose spinal diseases, doctors very often prescribe puncture of the spine, or rather the spinal canal, in order to obtain cerebrospinal fluid. The puncture point is chosen very carefully (there is a place in the spine where the risk of brain damage is minimized). The doctor begins the procedure only after the surgical field has been treated with antiseptics.
The indication for a spinal puncture is a suspicion of subarachnoid hemorrhage, in which the fluid is heavily stained with blood. In the same way, meningitis and inflammation of the meninges are diagnosed, including processes of tuberculous etiology.
Joint pathologies
Diagnosis of joint pathologies is carried out using lumbar puncture; this procedure is also performed for therapeutic purposes.
In this way, fluid is pumped out from the joint or injected medicinal product. The indication in this case is the presence of synovitis, which develops in the knee joints. In this case, the disease must be at the stage of overflowing the joint capsule with fluid. Puncture is also performed in case of hemarthrosis, when blood accumulates in the joint after an injury. Indications are also bursitis, suppuration of the bursa or cavity in the joints.
To diagnose the articular cavity, a slightly different technique is used, which has its own characteristics. When they pierce knee-joint, first anesthesia is performed, and then the needle pierces the joint cavity. Using a large syringe, negative pressure is applied, which allows the evacuation of blood or joint fluid, depending on the disease.
After the procedure, the puncture site is sealed with a plaster, and a pressure bandage is also applied to the joint itself. Piercing the joint with therapeutic purpose carried out when a drug is injected into a joint. Most often these are hormones for deforming osteoarthritis or elbow bursitis. When big size Baker's cyst can be punctured, which in some cases avoids surgical intervention.
Treatment of hemarthrosis
Hemarthrosis is also treated with puncture: a drug is injected into the joint to stop the bleeding. After pumping out fluid from the joint cavity, it is injected antibacterial agents to prevent suppuration.
When necessary diagnostic puncture? A few years ago, a procedure called pneumoarthrography was popular. The idea was that air was pumped into the joint cavity, and then X-rays were taken. IN last years this procedure was replaced by MRI or CT, which are more informative and less traumatic. In some situations, it is with the help of puncture that it is possible to diagnose breast cancer or a cyst. With the help of puncture, it is possible to establish a diagnosis of an abscess not only in the mammary gland, but also in other organs.
Indications for pleural puncture for hydrothorax
Pathologies in internal organs, metabolic disorders and hormonal imbalances can contribute to hydrothorax. This is the name given to the accumulation of fluid in pleural cavity inflammatory or non-inflammatory in nature. The indications for pleural puncture for hydrothorax are very serious. In this case, mandatory medical supervision is required and health care, depending on the severity of the disease from conservative treatment before urgent puncture.
The latter is a necessary step to determine the nature of the substance: exudative or non-inflammatory. X-rays and ultrasounds do not show this, so it needs to be collected and analyzed.
With chest injuries, a condition may develop in which air can accumulate in the pleural cavity, the so-called pneumothorax. In this case, puncture helps to remove it and restore negative pressure. With hemothorax (bleeding in chest cavity) puncture is a therapeutic method that allows you to remove accumulated blood.
Rules
In most cases, puncturing is painless, but anesthesia is given to avoid complications. There are other rules: all instruments, as well as the puncture site, must be disinfected. This allows you to avoid additional infection getting inside the tissues and cavities. When performing a puncture through the back wall of the vagina, the movement is done sharply and easily. During the procedure, care must be taken not to damage the wall of the rectum. If the cyst or cavity contains very thick exudate, then a sterile solution is injected inside. Only specialized clinics and medical offices. The procedure is quite complex, so it is carried out by an experienced specialist with extensive experience.
Consequences
In rare cases, some negative consequences may occur: injury to a blood vessel or endometrium in the uterus, decreased pressure, development of the inflammatory process, damage to the rectum, dizziness, deterioration general well-being or misdiagnosis. Spinal tap may result in damage spinal cord. Therefore, this procedure should only be performed by an experienced doctor. Understanding what a puncture is, you should not be afraid of this procedure.
Spinal cord puncture. Such a terrible phrase can often be heard at a doctor’s appointment, and it becomes even scarier when this procedure concerns you specifically. Why do doctors puncture the spinal cord? Is such manipulation dangerous? What information can be obtained during this study?
The first thing you need to understand when it comes to spinal cord puncture (which is what patients most often call this procedure), it does not mean a puncture of the tissue of the central organ itself. nervous system, but only the fence is not large quantity cerebrospinal fluid, which bathes the spinal cord and brain. Such manipulation in medicine is called a spinal, or lumbar, puncture.
Why is a spinal cord puncture performed? There can be three purposes for such manipulation: diagnostic, analgesic and therapeutic. In most cases, a lumbar puncture of the spine is done to determine the composition of the cerebrospinal fluid and the pressure inside the spinal canal, which indirectly reflects pathological processes occurring in the brain and spinal cord. But specialists can perform a spinal cord puncture for therapeutic purposes, for example, to administer drugs into the subarachnoid space, for rapid decline spinal pressure. Also, one should not forget about such an anesthesia method as spinal anesthesia, when anesthetics are injected into the spinal canal. This makes it possible to carry out a large number surgical interventions without application general anesthesia.
Considering that in most cases, spinal cord puncture is prescribed for diagnostic purposes, this type of research will be discussed in this article.
Why is a puncture taken?
A lumbar puncture is taken to examine the cerebrospinal fluid, which can help diagnose some diseases of the brain and spinal cord. Most often, such manipulation is prescribed for suspected:
- infections of the central nervous system (meningitis, encephalitis, myelitis, arachnoiditis) of a viral, bacterial or fungal nature;
- syphilitic, tuberculous lesions of the brain and spinal cord;
- subarachnoid bleeding;
- abscess of the central nervous system;
- ischemic, hemorrhagic stroke;
- traumatic brain injury;
- demyelinating lesions of the nervous system, such as multiple sclerosis;
- benign and malignant tumors brain and spinal cord, their membranes;
- other neurological diseases.
Cerebrospinal fluid examination makes it possible to quickly diagnose serious illnesses brain and spinal cord
Contraindications
Taking is prohibited lumbar puncture for space-occupying formations of the posterior cranial fossa or temporal lobe brain. In such situations, taking even a small amount of cerebrospinal fluid can cause dislocation of brain structures and cause strangulation of the brain stem in the foramen magnum, which entails immediate death.
It is also prohibited to perform a lumbar puncture if the patient has purulent-inflammatory lesions of the skin, soft tissues, or spine at the puncture site.
Relative contraindications are severe spinal deformities (scoliosis, kyphoscoliosis, etc.), since this increases the risk of complications.
With caution, puncture is prescribed to patients with bleeding disorders, those who take drugs that affect blood rheology (anticoagulants, antiplatelet agents, non-steroidal anti-inflammatory drugs).
For brain tumors, lumbar puncture can only be performed according to vital signs, since there is a high risk of developing dislocation of brain structures
Preparation stage
The lumbar puncture procedure requires preliminary preparation. First of all, the patient is prescribed general clinical and biochemical tests blood and urine, the state of the blood coagulation system is necessarily determined. The lumbar spine is examined and palpated. To identify possible deformations that may interfere with the puncture.
You need to tell your doctor about all the medications you are currently taking or have recently taken. Special attention should be given to drugs that affect blood clotting (aspirin, warfarin, clopidogrel, heparin and other antiplatelet agents and anticoagulants, non-steroidal anti-inflammatory drugs).
You should also tell your doctor about possible allergies for medications, including anesthetics and contrast agents, about recent acute diseases, about the presence of chronic ailments, since some of them may be a contraindication to the study. All women of childbearing age should tell their doctor about possible pregnancy.
IN mandatory Before performing a spinal cord puncture, the patient must consult a doctor
It is forbidden to eat for 12 hours before the procedure and drink for 4 hours before the puncture.
Puncture technique
The procedure is performed with the patient lying on his side. In this case, you need to bend your legs as much as possible at the knees and hip joints, bring them to the stomach. The head should be bent forward as much as possible and close to the chest. It is in this position that the intervertebral spaces expand well and it will be easier for a specialist to get a needle into Right place. In some cases, the puncture is performed with the patient sitting with the back as rounded as possible.
The specialist selects the puncture site by palpating the spine so as not to damage the nerve tissue. The spinal cord in an adult ends at the level of the 2nd lumbar vertebra, but in short people, as well as in children (including newborns), it is slightly longer. Therefore, the needle is inserted into the intervertebral space between the 3rd and 4th lumbar vertebrae or between the 4th and 5th. This reduces the risk of complications after puncture.
After skin treatment antiseptic solutions conduct local infiltration anesthesia soft tissues with a solution of novocaine or lidocaine using a regular syringe with a needle. After this, a lumbar puncture is performed directly with a special large needle with a mandrel.
This is what a spinal puncture needle looks like
The puncture is made at the selected point, the doctor directs the needle sagittally and slightly upward. At approximately a depth of 5 cm, resistance is felt, after which a peculiar dip of the needle follows. This means that the end of the needle has entered the subarachnoid space and you can begin collecting cerebrospinal fluid. To do this, the doctor removes the mandrin from the needle ( inner part, which makes the instrument airtight) and liquor begins to drip from it. If this does not happen, you need to make sure that the puncture is performed correctly and that the needle enters the subarachnoid space.
After collecting the cerebrospinal fluid into a sterile tube, the needle is carefully removed and the puncture site is sealed with a sterile bandage. For 3-4 hours after the puncture, the patient should lie on his back or side.
The puncture is performed between the 3rd and 4th or 4th and 5th lumbar vertebrae
The first step in cerebrospinal fluid analysis is to assess its pressure. Normal values in a sitting position are 300 mm. water Art., in a lying position – 100-200 mm. water Art. As a rule, pressure is assessed indirectly - by the number of drops per minute. 60 drops per minute corresponds to the normal value of cerebrospinal fluid pressure in the spinal canal. Pressure increases when inflammatory processes Central nervous system, with tumor formations, with venous stagnation, hydrocephalus and other diseases.
Next, the cerebrospinal fluid is collected into two 5 ml tubes. They are then used to carry out necessary list research – physicochemical, bacterioscopic, bacteriological, immunological, PCR diagnostics, etc.
Depending on the results of the cerebrospinal fluid study, the doctor can recognize the disease and prescribe appropriate treatment
Consequences and possible complications
In the vast majority of cases, the procedure takes place without any consequences. Naturally, the puncture itself is painful, but pain is present only at the stage of inserting the needle.
Some patients may develop the following complications.
Post-puncture headache
It is generally accepted that after a puncture a certain amount of cerebrospinal fluid flows out of the hole, as a result of which intracranial pressure decreases and a headache occurs. This kind of pain reminds headache tension, has a constant aching or squeezing nature, decreases after rest and sleep. It can be observed for 1 week after the puncture; if cephalgia persists after 7 days, this is a reason to consult a doctor.
Traumatic complications
Sometimes traumatic complications of puncture may occur, when the needle can damage the spinal nerve roots, intervertebral discs. This is manifested by back pain, which does not occur after a correctly performed puncture.
Hemorrhagic complications
If large blood vessels are damaged during the puncture, bleeding and hematoma formation may occur. This is a dangerous complication that requires active medical intervention.
Dislocation complications
Occurs when there is a sharp drop in cerebrospinal fluid pressure. This is possible if there is volumetric formations posterior cranial fossa. To avoid such a risk, before taking a puncture, it is necessary to perform a study for signs of dislocation midline structures brain (EEG, REG).
Infectious complications
They may occur due to violation of the rules of asepsis and antisepsis during puncture. The patient may develop inflammation of the meninges and even form abscesses. Such consequences of puncture are life-threatening and require the prescription of powerful antibacterial therapy.
Thus, spinal cord puncture is a very informative technique for diagnosing a large number of diseases of the brain and spinal cord. Naturally, complications during and after the manipulation are possible, but they are very rare, and the benefits of the puncture far outweigh the risk of developing negative consequences.
Spinal tap – 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 is not allowed to 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 due to a disease, the cerebrospinal fluid may increase, causing high blood pressure in the skull. If joins infectious process, then 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 introduction contrast agent;
- the need to reduce intracranial pressure and remove excess fluid;
- processes in the form 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! Be sure to exclude punctures before performing possible pathologies, contraindications and risks. Neglecting this 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.
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:
- blood and urine tests;
- 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 accepting correct position. There are two options:
- 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.
- 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 staff are training necessary tools and materials - a sterile needle with a mandrel (a rod for closing the lumen of the needle), a container for cerebrospinal fluid, 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. Exactly right places 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:
- skin puncture;
- intervertebral ligaments;
- 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 the amount of 2 ml, necessary for bacteriological research and the second - for liquor examined to determine the level of protein, sugar, cellular composition and 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 total quantity the 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 appear brain regions, urgent help is provided
After the puncture procedure, it is necessary to observe bed rest. It is allowed to get up after 2 days with normal indicators. 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, when in serious condition health.
Possible, but rare complications the following:
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.
Puncture - taking a tissue sample for analysis. It is carried out by puncturing an organ or tumor. Besides diagnostic purpose this procedure can also be performed for medicinal purposes. And today we will talk in detail about what it is puncture, does it hurt? how it is carried out.
Why is the puncture performed?
For diagnostic purposes, a puncture is performed by injecting a contrast agent to take tissue for analysis and to monitor pressure in various vessels. If the procedure is carried out for treatment purposes, injections are introduced into the organ or cavity. medications. In addition, using a puncture, excess liquid or gas is removed, and the organ is washed.
What types of punctures are there?
This procedure is used for different purposes and is performed on different organs. Therefore, puncture is divided into several types:
. Pleural puncture;Spinal cord puncture;
Sternal;
Liver biopsy;
Kidney biopsy;
Joint puncture;
Follicle puncture;
Breast puncture;
Thyroid puncture;
Umbilical cord puncture or cordocentesis;
Ovarian cyst puncture.
Diagnostic puncture
In most cases, this manipulation takes place under general or local anesthesia. In this case, the question puncture, does it hurt? we can say that the procedure is completely painless. In cases where the procedure is performed without anesthesia, it feels similar to a regular injection during vaccination. To carry out a puncture, a thin hollow needle is used, which is carefully inserted into the desired area, for example, into a cyst. The internal fluid is then sucked out using a syringe. When the sample is received, it is sent for further histological examination to the laboratory. Depending on the organ, the procedure and the needle used may vary slightly, but in any case the principle remains the same.
Usually the puncture does not take more than 15 minutes, although 1 minute is enough for the puncture itself. The patient can be in a sitting or lying position, depending on the purpose of the study. Do not move while collecting the sample. If the patient moves involuntarily, the needle may damage nearby tissue or blood vessels. This will lead to unpleasant consequences.
Therapeutic puncture
For therapeutic purposes, puncture is performed in the same way. To reduce pain, anesthesia is performed. The puncture site is treated with alcohol or iodine solution. The only difference is that medicinal solutions are pumped in or excess fluid is removed. If from tumor formation When the liquid is pumped out, it is sent for further study to the laboratory. This is necessary in order to accurately determine the cause of the tumor and thereby prevent relapse. The procedure can be carried out repeatedly. If indicated, it is used for both adults and children. The duration of the puncture in this case is on average 20 minutes, it depends on the organ being manipulated.
After the procedure
In most cases, rehabilitation after puncture is not required, but if necessary, it can last from 2 hours to a day. During this time, the patient is in the clinic, under the supervision of medical workers. This is necessary to prevent possible complications. After the puncture, minor pain, lethargy and nausea may occur. These are the consequences of anesthesia and puncture. All these sensations pass on their own, but various medications, including painkillers, can also be prescribed. The patient does not experience serious pain either during or after the procedure. Therefore, the puncture is considered painless and safe procedure. In our center, the puncture is carried out quickly and efficiently. You will not feel any pain. Come to our center in Moscow, we will definitely help you!
Lumbar puncture, or lumbar puncture, is a diagnostic or therapeutic procedure, performed in outpatient setting using local anesthesia. The purpose of a diagnostic lumbar puncture is to take a sample of cerebrospinal fluid, laboratory testing of which will confirm or exclude suspicion of any diagnosis. WITH therapeutic purpose the collection of a certain volume of cerebrospinal fluid is most often used to reduce intracranial pressure or administration of medications.
Some anatomical characteristics of the structure of the spinal cord and its membranes
The spinal cord is the main channel for transmitting information connecting the brain and the peripheral nervous system, innervating all organs and tissues located below the base of the skull. The organ is enclosed in the spinal canal, which runs inside the bony base of the vertebrae. A characteristic feature of the spinal cord is that its length is much shorter spinal column. The spinal cord originates as a continuation medulla oblongata and reaches the second lumbar vertebra, where it ends in the form of a fibrous extension called the filum terminale or “cauda equina.”
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 spine, the spinal cord forms characteristic thickenings, from which large numbers of nerve plexuses arise, causing 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 organ, it is enveloped in three successive layers of tissue, providing its additional safety and functional tasks.
- Dura mater is the outer layer lining the spinal canal, to which it is loosely adjacent - a cavity is formed between the membrane and the walls of the canal, called the epidural space. Epidural space for the most part filled with adipose tissue and penetrated by a wide network blood vessels, which provides the shock-absorbing and trophic needs of nearby tissues, including the spinal cord.
- Arachnoid or arachnoid medulla is the middle layer covering the spinal cord.
- Pia mater. Between the arachnoid and pia mater is formed the so-called subarachnoid or subarachnoid space, which is filled with 120-140 ml of cerebrospinal fluid(cerebrospinal fluid 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 to the same space in the skull, which ensures a constant exchange of fluid between the cranial and spinal cavities, the boundary between which is considered to be the opening of the fourth ventricle of the brain.
- At the end of the spinal cord, the nerve roots of the cauda equina float freely in the cerebrospinal fluid.
Biologically, the arachnoid membrane is represented by a network of interwoven threads connective tissue, externally resembling a web, which explains its name.
It is extremely rare to combine the arachnoid and pia mater, giving them a common name leptomeninges, and hard meninges isolated as a separate structure, pachymeninx.
In what cases is it necessary to perform a lumbar puncture?
A lumbar puncture is performed from the lumen of the subarachnoid space between the dura mater and the arachnoid membrane of the spinal cord in the lumbar spinal column, where the spinal cord completes its length. This area helps reduce the risks associated with physical damage to the spinal cord.
The collection of cerebrospinal fluid for diagnostic indications is carried out in view of the exclusion of infectious, inflammatory and tumor pathologies that can have a detrimental effect on the central nervous system.
More often the reason for the sampling may be a suspicion of meningitis , for the diagnosis of which there is no more reliable method than laboratory testing of cerebrospinal fluid.
Large concentrations of colonies of trypanosomes (microorganisms), causing quite rare, but very severe infection the man known as sleeping sickness or African trypanosomiasis , is contained precisely in the cerebrospinal fluid.
In newborns, a lumbar puncture is often performed to exclude complications such as meningisms, when fever of unspecified etiology is detected and genesis.
In addition, at any age, a number of diseases can be confirmed or excluded using laboratory research cerebrospinal fluid.
- Subarachnoid hemorrhage.
- Multiple sclerosis.
- Hydrocephalus.
- Benign intracranial hypertension and other non-infectious pathologies.
One of the most common indications for a spinal puncture is the suspicion of malignant oncogenesis in the central nervous system. Carcinomatous meningitis and medulloblastomas often cause the presence of free-floating metastatic formations in the spinal cerebrospinal fluid.
Therapeutic spectrum There are several indications for lumbar puncture at same. Antibiotics are often injected into the lumen of the subarachnoid space for infectious pathologies in order to quickly deliver the drug to the pathological focus and accumulate it in sufficient concentration. In some malignant oncological pathologies of the brain and spinal cord, cerebrospinal fluid is used as a delivery system to provide the necessary dosages of chemotherapy around the tumor.
In addition, a puncture is used when a surgical intervention in the area of the spinal column.
Pumping out the required amount of cerebrospinal fluid is often indicated with increased intracranial pressure, usually arising as a result of cryptococcal meningitis or hydrocephalus with normal intracranial pressure.
Contraindications for lumbar puncture
Given pathological condition characterized by individual displacements of some cerebral areas relative to their normal location. This phenomenon occurs due to increased intracranial pressure, when physical forces stimulate invagination, herniation or pinching of the brain parenchyma and, as a consequence, its pathological contact with anatomical features cranial bones. Most often, the effects of the formation of hernial strangulations of the brain into separate cavities filled with cerebrospinal fluid, which physiologically serve as a cerebrospinal fluid reservoir, are observed.
The collection 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 sudden death.
Thus, lumbar puncture as a therapeutic effect for increased intracranial pressure is performed with great caution, having previously completely excluded phenomenon of cerebral dislocation.
Technique for performing cerebrospinal fluid puncture
The technique of puncture is not particularly difficult, however, specialists who have experience in puncture or have undergone training on artificial emulators are allowed to perform the procedure.
The puncture is performed on an outpatient basis. Conducting it at home is strictly prohibited due to the lack of resuscitation capabilities in case of an unsuccessful puncture.
Before the puncture, no additional preparation of the patient is required, except psychological, since the very fact of a deep puncture in the spine is quite difficult for emotional perception.
There is a certain procedure for carrying out the procedure.
- The patient is placed in the lateral or sitting position.
- Regardless of the position the back should be bent as much as possible, which is ensured by tightly pressing both knees to the stomach and clasping them with your hands. This position helps to create the largest possible space for advancing the needle, eliminating the risk of it being pinched 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 the extension for the cauda equina is formed. This puncture site is typical for adults, but 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 a 1-2% solution of novocaine for the purpose of local anesthesia, when the drug is administered in layers, approximately every 1-2 mm of the needle insertion depth, squeezing out a small amount of solution.
- Bir's needle resembles a classic injection needle, but much larger in length and diameter of the internal hole. The needle is inserted strictly according to midline the spinal column between the spinous processes of these vertebrae until a sensation of failure is felt 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 ensured by the position of the back during puncture, so the use of suction manipulations is not required.
- Before and after the puncture, its place is treated antiseptics, and upon completion is sealed with a sterile adhesive tape.
- The patient is asked to lie on his stomach and try to remain as static as possible for 2 hours, which will ensure uniform distribution of cerebrospinal fluid to replace the withdrawn fluid. When administering drugs, a state of rest will ensure synchronization of pressure in the subarachnoid space throughout its cavity, as well as uniform exposure to the drug, which reduces the level of side effects after puncture.
Possible consequences and complications of the procedure
Considering such active interference in the functionality of the cerebrospinal fluid, spinal cord, as well as its direct anatomical and physiological contact with the brain, Lumbar puncture can cause a significant number of side effects and complications.
Very severe pain in the lumbar region, accompanied by nausea- a fairly common occurrence after puncture, which is explained specific effects of analgesics that enter the cerebrospinal fluid and directly affect the neurons of the spinal cord and brain. Intravenous administration caffeine often helps suppress this side effect, but the drug is used in the absence of contraindications to it, of which there are quite a few.
Needle-root contact spinal nerve often causes feeling of loss motor functions lower limbs and quite strong pain, about which the patient should 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 lumbar puncture for the next 5-7 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 may accompany the patient for a much longer period and be characterized as painful if the puncture was performed in sitting position. The reason for the phenomenon lies in the excessive release of cerebrospinal fluid through the puncture channel into the ligamentous tissue or under the skin. The puncture channel remains open quite long time, since the cerebrospinal fluid that has penetrated into its lumen does not contain thickening elements that contribute to clogging the hole. In some cases, experienced specialists, after obtaining the required amount of cerebrospinal fluid, during withdrawal of the needle, inject small amounts of fresh blood from the patient, taken from a vein in advance. This method allows you to block the canal, but is somewhat dangerous, because blood clots should not get into the subarachnoid space.
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