How to operate when using puncture?

Usually take the bent back position, from the lumbar 2 to the sacral 1 (mainly lumbar 3-4) intervertebral space puncture. After local routine disinfection and anesthesia, wear rubber gloves, and use a 20-gauge puncture needle (21-22 for children) to slowly pierce along the spinous process. During the needle insertion process, the needle tip encounters bone. The needle is withdrawn to the subcutaneous surface and the angle is corrected before puncturing. When the needle is inserted about 4-150px for adults (about 3-100px for children), the dura can be penetrated and the subarachnoid space can be reached. ), then insert the needle core and pull out the puncture needle. Slight pressure on the puncture point to stop bleeding, apply sterile gauze and fix it with tape. Lie down for 4-6 hours after surgery. If the initial pressure exceeds 2.94kPa (300mm water column), it is not suitable to discharge the liquid, and only the cerebrospinal fluid in the pressure measuring tube is sent for cell counting and protein quantification. Instruct the patient to lie on the side of the hard board bed, with the back perpendicular to the bed surface, flex the head forward to the chest, and hold the knees with both hands close to the abdomen, so that the body is arched; Hands hold the carcass of both lower limbs and hold them tightly to make the spine kyphosis to widen the intervertebral space and facilitate needle insertion. Determine the puncture point, take the intersection of the line connecting the posterior superior spine of the iliac and the posterior median line as the puncture point, generally take the 3rd-4th lumbar spinous process space, and sometimes it can also be performed in the upper or lower lumbar intervertebral space. After routine disinfection of the skin, sterile gloves and a hole-covering patch were worn, and 2% lidocaine was used for local infiltration anesthesia layer by layer from the skin to the intervertebral ligament. The surgeon fixes the skin of the puncture point with the left hand, and holds the puncture needle with the right hand to slowly pierce in the direction of the vertical north. The depth of the needle is about 4-150px for adults and 2-100px for children. When the needle passes through the ligament and dura, you can feel the sudden loss of resistance and a sense of loss. At this time, the needle core can be slowly withdrawn (to prevent the rapid outflow of cerebrospinal fluid, resulting in brain herniation), and the outflow of cerebrospinal fluid can be seen.

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