How to operate when using puncture?

Usually in a bent lateral position, intervertebral puncture is performed from lumbar 2 to sacral 1(mainly from lumbar 3-4). After routine local disinfection and anesthesia, wear rubber gloves and slowly Pierce with a 20-gauge puncture needle (21-22 for children) along the spinous process. During the process of needle insertion, the needle tip encounters bone. During lumbar puncture, the needle should be retreated to the subcutaneous area to correct the Angle before puncture. When the needle is inserted about 4-150px in adults (about 3-100px in children), the dura can be penetrated to reach the lower cavity of the spider web. The needle core can be withdrawn to drain the cerebrospinal fluid. After measuring the pressure and slowly draining the fluid (not more than 2-3ml), the needle core can be inserted to pull out the puncture needle. The puncture point was slightly pressurized to stop bleeding, applied with sterile gauze and fixed with tape. Supine position for 4-6 hours after operation. If the initial pressure exceeds 2.94kPa(300mm water column), the fluid should not be discharged, and only the cerebrospinal fluid in the pressure measuring tube can be sent for cell counting and protein quantification. Ask the patient to lie on the side of the hard bed, back and bed vertical, head forward chest flexion, hands holding knee close to the abdomen, so that the body thousand bow; Or the assistant held the patient's head with one hand and the other hand at the LM of the lower extremities and held the patient tightly to make the spine kyphotic to widen the intervertebral space and facilitate needle entry. To determine the puncture point, the intersection of the posterior superior iliac spine line and the posterior median line was taken as the puncture point. Generally, the spinous process space of the 3rd to 4th lumbar vertebrae was taken, and sometimes the space of the upper or lower lumbar vertebrae was also taken. After routine disinfection of the skin, sterile gloves were put on to cover the hole, and local infiltration anesthesia was performed with 2% lidocaine layer by layer from the skin to the intervertebral ligament. The surgeon fixed the skin of the puncture site with the left hand, and held the puncture needle in the right hand to slowly Pierce the needle in a vertical north direction. 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, the resistance can be felt suddenly disappear and there is a sense of disappointment. At this point, the needle core can be slowly withdrawn (to prevent cerebrospinal fluid from rapidly flowing out, causing brain herniation), that is, CSF outflow can be seen.

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