How do you do it with a puncture?

Usually, the patient was placed in the bent lateral position, and intervertebral puncture was performed from the 2nd to the 1st sacral (mainly the 3rd to 4th lumbar). After local routine disinfection and anesthesia, wear rubber gloves and slowly Pierce the needle with no. 20 (No. 21-22 for children) along the direction of spinous process. During the process of needle insertion, the needle tip meets bone. When the needle is injected about 4-150px for adults (about 3-100px for children), the dural membrane can be punctures to reach the subnet cavity of the aracinula membrane. The needle core can be extracted and the cerebrospinal fluid can be discharged. After pressure measurement and slow drainage (no more than 2-3ml), the needle core can be inserted and the puncture needle can be pulled out. The puncture site was slightly pressurized to stop the bleeding, applied with sterile gauze and fixed with tape. Lie supine for 4-6 hours after surgery. If the initial pressure exceeds 2.94kPa(300mm water column), it is not suitable to discharge fluid. Only take cerebrospinal fluid from the pressure measuring tube and send it to cell count and protein quantition. Ask the patient to lie on the hard bed side, the back is perpendicular to the bed surface, head forward chest flexion, hands hugging knees close to the abdomen, so that the body is arched; Or the assistant held the patient's head with one hand opposite the surgeon and held the equator with the other hand, making the day kyphosis of the spine to widen the vertebral space and facilitate needle insertion. The puncture point was determined, and the intersection of the line between the superior posterior iliac spine and the posterior median line was taken as the puncture point. Generally, the 3-4 lumbar spinous process space was taken, and sometimes it could also be performed in the upper or lower lumbar space. After routine skin disinfection, sterile gloves were put on, and the local infiltration anesthesia was performed layer by layer with 2% lidocaine from the skin to the intervertebral ligament. The surgeon fixed the skin of the puncture site with the left hand, and slowly penetrated the skin with the puncture needle in the vertical north direction with the right hand. The depth of the needle was about 4-150px for adults and 2-100px for children. When the needle passes through the ligaments and dura mater, the resistance is suddenly lost and there is a sense of disappointment. At this time, the needle core can be slowly withdrawn (to prevent rapid outflow of cerebrospinal fluid, causing cerebral hernia), that is, outflow of cerebrospinal fluid can be seen.