lumbar puncture needle doctor operation

After finding out the landmarks again, the physician inserts a puncture needle with a needle core at the midline position and the upper edge of the next spinous process. The needle is facing the head, about 15 degrees, which seems to be facing the direction of the patient's umbilicus. CSF leakage can cause post-puncture headaches, and recent data suggest that the use of "pencil-like" needles may reduce the risk of headaches because they allow the fibers of the dural sac to loosen without severing them. If the more commonly used beveled needles are used, the bevel of the needle should be in the sagittal plane, which also allows the fibers parallel to the spinal axis to spread out without severing them.

If the needle is inserted in the correct position, the needle should be passed through the skin, subcutaneous tissue, supraspinous ligament, interspinous ligament between spinous processes, ligamentum flavum, and epidural space (including the internal vertebral venous plexus, dura mater, and arachnoid) in order. , enters the subarachnoid space and is located between the roots of the cauda equina. As the needle passes through the ligamentum flavum, the physician can feel a sense of breakthrough. At this time, the needle core should be pulled out 2 mm to observe whether there is cerebrospinal fluid outflow. If the puncture is unsuccessful and touches the bone, withdraw the puncture needle to the subcutaneous tissue, but do not withdraw from the skin, adjust the direction and insert the needle again. Once the needle enters the subarachnoid space, there is CSF outflow. If there is trauma during the puncture, the CSF may be slightly bloody. When the CSF is collected, the CSF should be clear and bloodless, unless there is subarachnoid hemorrhage. If the flow of CSF is poor, the needle may be rotated 90 degrees because the opening of the needle may be blocked by a nerve root.

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