Lumbar puncture needle method and steps

Lumbar puncture is usually performed in the lateral decubitus position, and the intervertebral space is punctured from lumbar 2 to sacral 1 (mainly lumbar 3-4). -22#) slowly pierce along the spinous process direction. When the needle tip encounters bone during the needle insertion process, the needle should be withdrawn to the subcutaneous surface and the angle should be corrected before puncturing. The needle insertion is about 4-6cm for adults (about 3-4cm for children). ), the dura can be penetrated to reach the subarachnoid space, the core of the needle is drawn out to flow out the cerebrospinal fluid, the pressure is measured and the fluid is slowly discharged (no more than 2-3ml), then the core of the needle is inserted and the puncture needle is pulled out. Apply a little pressure to stop bleeding, apply sterile gauze and fix it with adhesive tape. Lie down for 4-6 hours after surgery. If the initial pressure exceeds 2.94kPa (300mm water column), it is not appropriate to discharge the fluid. Only the cerebrospinal fluid in the manometry tube is taken for cell count and protein quantification.

1. Instruct the patient to lie on the side on the hard board bed, with the back perpendicular to the bed surface, flex the head forward and the chest, and hold the knees with both hands close to the abdomen, so that the torso is arched; With the other hand, hold the fossa of both lower limbs and hold them tightly, so that the spine is kyphotic during the day to widen the intervertebral space and facilitate needle insertion.

2. 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 3-4 lumbar spinous process space, and sometimes it can also be performed in the upper or lower lumbar intervertebral space.

3. After routine disinfection of the skin, wear sterile gloves and cover holes, and use 2% lidocaine for local anesthesia from the skin to the intervertebral ligament.

4. 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 vertical north direction. The depth of the needle is about 4-6cm for adults and 2-4cm for children. When the needle passes through the ligament and dura mater , you can feel that the resistance suddenly disappears and you feel a sense of loss. At this time, the needle core can be slowly drawn out (to prevent the rapid outflow of cerebrospinal fluid and cause brain herniation), you can see the outflow of cerebrospinal fluid.

5. Connect the piezometric tube to measure the pressure before the liquid is discharged. The normal cerebrospinal fluid pressure in the lateral position is 0.69-1.764kPa or 40-50 drops/min. If you know whether the subarachnoid space is blocked, you can do the Queckenstedt test. That is After measuring the initial pressure, the assistant first compresses one side of the jugular vein for about 10s, then the other side, and finally both sides of the jugular vein at the same time; under normal circumstances, after the jugular vein is compressed, the cerebrospinal fluid pressure immediately doubles and releases the pressure. After 10-20s of compression, it quickly drops to the original level, which is called negative obstruction test, indicating that the subarachnoid space is unobstructed. Complete obstruction; if the pressure rises slowly after applying pressure, and then falls slowly after relaxation, it indicates incomplete obstruction. This test is forbidden for those with increased intracranial pressure.

6. Remove the pressure measuring tube and collect 2-5ml of cerebrospinal fluid for inspection; if it is necessary for culture, use aseptic operation to keep the specimen.

7. After the operation, insert the needle core and pull out the puncture needle together, cover it with sterile gauze, and fix it with tape.

8. After the operation, the patient should go to the prone position (if difficult, lie down) for 4-6 hours, so as to avoid postoperative hypotension headache.

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