How to implement the inspection cooperation of lumbar puncture?

The inspection and coordination of the implementation of lumbar puncture: 1. Check the patient's bed number and name, explain the purpose of the operation to the patient, eliminate tension and fear, and obtain cooperation. 2. Prepare the supplies and bring them to the patient's bed, shielded by a screen. 3. Positioning position: Instruct the patient to lie on a hard board bed on the left side, with the back flush with the bed, lay out disposable pads and treatment towels, bend the head to the chest, bend the knees to the abdomen, hold the knees with both hands, and arch the back as far as possible. rise.

  For those with impaired consciousness or physical mobility, the nurse assists the patient in positioning the puncture site fully. 4. Determine the puncture point: generally take the L3-L4 lumbar intervertebral space for adults, and take the fifth lumbar intervertebral space for children. The intersection of the iliac crest connecting line and spinal spinal line on both sides is the third lumbar intervertebral space. 5. Disinfection: Routinely disinfect the puncture site, centered on the puncture point, with a diameter >15cm.

  6. Local anesthesia: Open the puncture kit, the surgeon wears sterile gloves, spreads a sterile drape, and uses 2% lidocaine for local infiltration anesthesia. 7. Puncture: The surgeon holds a lumbar puncture needle (with a needle core) and inserts the needle vertically along the lumbar intervertebral space. When it is advanced to a depth of 4-6cm (children 2-3 cm), the sudden resistance suddenly disappears, indicating that the needle has entered the spinal cavity.

  During the puncture process, cooperate with the nurse to assist the patient to maintain the correct posture of the lumbar puncture, communicate with the patient more, and closely observe the patient's condition. If there is any change in consciousness, pupils, pulse, breathing, etc., immediately report the doctor to stop the operation and assist in the rescue. 8. Pressure measurement: After the puncture is successful, ask the patient to relax, slowly pull out the needle core, and connect the pressure tube. The liquid level rises slowly. After reaching a certain level, the liquid level fluctuates with breathing. This reading is the cerebrospinal fluid pressure.

  If you need to know whether the subarachnoid space is obstructed, you can assist the doctor to do a dynamic test (also called a neck pressure test). That is, after the initial pressure is measured, the patient's side of the jugular vein is compressed for 10 seconds, and the cerebrospinal fluid level in the pressure tube is observed whether the level is elevated. 9. Retain specimens: If the intracranial pressure is not high, the needle core can be removed, and 3-5ml of cerebrospinal fluid can be collected for examination. If bacterial culture is required, strict aseptic operations should be performed to prevent the specimen from being contaminated; if the pressure is significantly increased, the needle core cannot be completely pulled out, so that the cerebrospinal fluid drips out slowly to prevent the formation of cerebral hernia; if intrathecal injection is required, the The liquid medicine is injected slowly.

  10. Needle removal: After the operation, the needle core is inserted, the lumbar puncture needle is pulled out, the needle hole is disinfected with povidone iodine, covered with sterile gauze, and fixed with tape. Observe closely for pain, edema, or bleeding at the puncture site. 11. Organize: Assist the patient to go to the supine position, organize the bed, clean up the supplies, and send the specimens for inspection in time. 12. Record: Timely record the operation process, the amount, color, nature of the cerebrospinal fluid, the patient's condition changes, the inspection items and the name and dosage of the spinal canal injection.

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