Lumbar puncture needle operation method

The patient lies on the side on a hard bed, with his back perpendicular to the bed surface, his head flexed forward to his chest, and his hands holding his knees close to his abdomen, so that his torso is arched. Or by the assistant standing opposite the surgeon, with one hand around the patient's head, the other hand around both lower limbs? Fossa and firmly hold, so that the spine as far as possible posterior protruding, to increase the width of the intervertebral space, easy to enter the needle. 2. The puncture point is at the intersection of the line of the posterior superior iliac spine and the posterior midline. Usually, the space between the spinous process of the third to fourth lumbar spine is taken, or the upper or next vertebral space can be carried out. 3. The skin was routinely disinfected, sterile gloves were worn, disinfection towel was laid, and local infiltration anesthesia was performed with 2% lidocaine from the skin to the intervertebral ligament. 4. The performer in the left hand thumb, food is held fixed skin puncture point, right hand holding the needle in the back of the vertical direction slowly Pierce, when the needle through the ligament and the catheter, can feel the resistance suddenly disappeared (adult into needle depth of 4 ~ 6 cm, children of 2 ~ 4 cm), the core needle slowly pulled out, is colorless transparent cerebrospinal fluid flow. 5. When the cerebrospinal fluid is about to flow out, connect the pressure tube to measure the pressure, accurate reading, can also count the number of cerebrospinal fluid drops to estimate the pressure (normal 70 ~ 180mmH2 O or 40 ~ 50 drops. Min). If the pressure is not high, can make 10 s assistant oppression side jugular vein, and then the other side, finally press the bilateral jugular vein at the same time, about twice as if cerebrospinal fluid pressure rise rapidly, relieve pressure after 10 ~ 20 s, and quickly fell to the original level, said subarachnoid unobstructed, if oppression vein pressure does not rise, after subarachnoid completely blocked, If the pressure rises slowly after compression and falls slowly after relaxation, it indicates incomplete obstruction. 6. The pressure tube was removed and 2 ~ 5ml of cerebrospinal fluid was collected for routine, biochemical and bacterial culture. 7. For the treatment of meningeal leukemia, usually with 4ml normal saline diluted MTX 10mg, dexamethasone 5mg, slowly injected into the spinal canal, while pushing back, with cerebrospinal fluid continuously diluted drug concentration, usually completed within 10min injection. 8. After inserting the needle core, pull out the needle together, cover it with sterile gauze, and fix it with adhesive tape. 9. After the operation, go to the pillow and lie on the back for 4-6 hours, which can avoid the postoperative headache of low cranial pressure. The tissues passed by the lumbar puncture are skin, subcutaneous tissue, supracspinous ligament, interspinous ligament, ligamentum flavum (into the epidural space, commonly known as epidural anesthesia is here), continue to Pierce the dura and arachnoid, into the subarachnoid space, that is, cerebrospinal fluid outflow. Therefore, during the puncture, there were two feelings of disappointment, one was ligamentum flavum and the second was arachnoid membrane. Compared with the first one, the feeling of disappointment was stronger.

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