Lumbar Puncture Needle Should Adopt The Body Position?

Lumbar puncture

1) Indications

1. The diagnosis and differential diagnosis of inflammatory diseases of the central nervous system include purulent meningitis, tuberculous meningitis, viral meningitis, mycotic meningitis, Japanese encephalitis, etc.

2. The diagnosis and differential diagnosis of cerebrovascular accidents include cerebral hemorrhage, cerebral infarction, subarachnoid hemorrhage, etc.

3. Diagnosis and treatment of neoplastic diseases Meningeal leukemia is diagnosed and treated by intrathecal injection of chemotherapy drugs through lumbar puncture.

(2) Operation method

1. The patient lies on the side of the hard bed, the back is perpendicular to the bed surface, the head is bent forward to the chest, the hands hug the knees close to the abdomen, so that the trunk is arched. Or by the assistant stand opposite the operator, with one arm around the patient's head, the other arm around the lower limbs � fosse and force to hold, so that the spine as far as possible after the process, to increase the width of the vertebral space, easy to enter the needle.

2. The puncture point is the intersection of the posterior superior iliac spine line and the posterior median line. Usually, the space of the spinous process of the 3rd to 4th lumbar spine is taken, and it can also be performed in the previous or next intervertebral space.

3. Routine disinfection of the skin, wearing sterile gloves, disinfection cloth, 2% lidocaine from the skin to the intervertebral ligament as local infiltration anesthesia.

4. The performer in the left hand thumb and forefinger deep puncture of the fixed point of skin, 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 measurement tube to measure the pressure, accurate reading, can also count the number of cerebrospinal fluid drops to estimate the pressure (normal 70 ~ 180mmH

2 O or 40 to 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 drops slowly after relaxation, it indicates incomplete obstruction.

6. Remove the pressure tube, collect 2-5 ml cerebrospinal fluid, and send it for routine, biochemical and bacterial culture tests.

7. Such as meningeal leukemia treatment, usually with 4ml saline diluted methotrexate (MTX) 10mg, add dexamethasone 5mg, slow intraspinal injection, push and pull back, with cerebrospinal fluid continuous dilution of drug concentration, usually in 10min injection completed.

8. At the end of the operation, after inserting the needle core, pull out the puncture needle together, cover with sterile gauze, and fix with tape.

9. Postoperative occipital supine lying for 4 ~ 6h can avoid postoperative intracranial hypotension headache.

(3) Matters needing attention

1. Strictly aseptic operation to avoid microvascular injury during puncture.

2. Stop the operation immediately if the patient has abnormal changes in respiration, pulse, pallor and so on during the puncture.

3. In intrathecal administration, the same amount of cerebrospinal fluid should be released first, and then the same volume of drug injection should be given to avoid causing headache caused by high or low intracranial pressure.

(4) Contraindications

1. Patients with elevated intracranial pressure.

2. Shock, failure, or endangered patients.

3. Local skin inflammation (near the puncture point).

1. purpose

Cerebrospinal fluid was taken and the pressure of cerebrospinal fluid was examined. Oxygen or iodine injection was injected into the spinal canal for brain and myelography to aid diagnosis. Drainage of inflammatory secretions, bloody cerebrospinal fluid or contrast media from the spinal canal, and release of appropriate amount of cerebrospinal fluid to improve clinical symptoms.

2. indications

It is often used in cerebrovascular diseases, infectious diseases of the central nervous system, after craniocerebral surgery, craniocerebral trauma, spinal cord diseases and so on.

3. contraindicated

3.1 Lumbar puncture is contraindated in patients with significantly increased intracranial pressure, especially with space-occupying lesions in posterior fossa, or suspected early cerebral hernia to prevent brain hernia and sudden death.

3.2 Lumbar puncture is forbidden for patients with infected lesions on the skin or subcutaneous tissue at the puncture site to prevent bacteria from entering the central nervous system.

3.3 Patients with systemic infectious diseases such as sepsis. Lumbar puncture should not be forced for patients with extremely critical condition, restiness or high cervical spine trauma or occupying lesions.

4. With content

Treatment plate: 2% iodine, 75% alcohol, sterile cotton ball. Gauze, 1-2% procaine, sterile lumbar puncture kit, pressure measuring tube, sterile gloves. Tape, matches, clean test tubes. Prepare culture tube and alcohol lamp when culture is needed.

5. Patient preparation

5.1 Procaine allergy test should be performed before puncture.

5.2 Empty urine and feces before puncture.

5.3 During puncture, the patient lies on the side of the bed with his hands hugging his knees, knees bending toward the chest, head bending forward, and hugging into a spherical shape. The spine should be parallel to the bed surface, and the pelvis should be vertical to the bed surface, so as to increase the lumbar space for puncture.

6. methods

6.1 Place the lumbar puncture disc next to the patient's bed and assist the patient in positioning.

6.2 During puncture, special personnel should be assigned to fix the patient's position and avoid moving to prevent the needle from breaking.

6.3 At the puncture site, the third, fourth or fourth and fifth lumbar interspaces were punctured. After successful puncture, cerebrospinal fluid outflow was observed. Assist the physician to install a pressure tube and compress the jugular vein or abdomen to observe the dynamic status of CSF and record the pressure before and after CSF outflow.

6.4 During the puncture process, pay attention to the changes of the patient's complexion, consciousness, pupils, pulse and breathing. Report any abnormality to the doctor immediately, stop the operation and assist in rescue.

6.5 For cerebrospinal fluid bacterial culture, the sterile tube mouth should be sterilized by flame on an alcohol lamp or directly connected to the outflow of cerebrospinal fluid with a petri dish. After disinfection of the tube by the above method, the sterile plug should be covered and immediately submitted for examination. If the intracranial pressure is high, the cerebrospinal fluid can not flow out quickly, should take 1mm diameter pressure measurement tube to make the cerebrospinal fluid flow out slowly, to prevent brain herniation.

6.6 After lumbar puncture, the puncture point should be covered with sterile gauze.

7. Matters needing attention

7.1 Strict aseptic operation, cerebrospinal fluid collection immediately submitted to test.

7.2 Do not put cerebrospinal fluid too fast to prevent cerebral sores.

7.3 Coordination operation should be skilled, avoid rough, needle withdrawal should be slow, so as to avoid cerebrospinal fluid leakage.

8. nursing

8.1 Explain the significance and precautions of puncture to the patient before puncture to facilitate cooperation.

8.2 Before puncture, procaine test was performed on the patient to prepare the lumbar puncture disc.

8.3 Assist the patient in positioning.

8.4 After puncture, the patient was instructed to lie supine for 4-6 hours.

8.5 Patients with postoperative headache and body temperature rise should be closely observed for meningitis.

8.6 If patients have nausea, vomiting, dizziness and headache after operation, they can be allowed to rest supine, and if necessary, they can be given static vomiting and analgesics according to the doctor's advice.

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