Take a puncture. Features of preparation for lumbar puncture of the spinal cord: why is a cerebrospinal fluid analysis done? What is a puncture and how is it taken?

Spinal cord puncture is a method of neurosurgical diagnosis based on the introduction of a special medical needle into the central spinal canal in order to obtain fluid circulating in the subarachnoid space. In some cases, the procedure is used for therapeutic and prophylactic purposes for local administration of drugs (for example, after neurosurgical operations on the spine). Thanks to extensive experience in carrying out such manipulations, today it is possible to significantly reduce the risks of severe consequences, but a small probability of complications after puncture of the subarachnoid space of the spinal cord is still present. For prevention possible pathologies it is necessary to follow all the instructions of the doctor and his assistants during the procedure itself, and also adhere to the recommendations regarding the regimen for at least three days after the lumbar puncture.

The main purpose of puncturing the subarachnoid space is to obtain cerebrospinal fluid (CSF) for further assessment of microbiological and biochemical parameters. Liquor is a clear, colorless liquid that fills the CSF pathways, protects the brain from mechanical stress and maintains normal intracranial pressure. For patients suffering from increased ICP, a puncture of the subarachnoid space is indicated to remove excess fluid and is performed as an emergency medical care for the prevention of strokes and hydrocephalus, which is also called cerebral hydrocephalus.

Indications for use

The absolute indications for puncturing the subarachnoid space are the presence clinical symptoms infectious and inflammatory diseases of the spine meninges, as well as various autoimmune and metabolic disorders central nervous system. Assessment of the chemical composition and rheological properties of the fluid produced in ependymal cells is necessary for patients with leukodystrophy, a severe hereditary disease that affects the white matter of the brain (a collection of long cylindrical processes nerve cells covered with a myelin sheath). For some types of neuropathies, the doctor may also suggest performing a lumbar puncture to clarify the etiological and pathogenetic picture of CNS damage.

The procedure may also be indicated in the presence of the following conditions and pathologies:

• presence of signs that may indicate hemorrhage in the subarachnoid space(acute headache, pulsation in the occipital and temporal parts of the head, convulsions, impaired consciousness, repeated vomiting, etc.);
• the need to introduce contrasts for other diagnostic methods;
• the need for emergency reduction of ICP;
• malignant tumors spine, dorsal, bone marrow and other organs and tissues, the study of cerebrospinal fluid in which will allow us to obtain a more accurate picture of the disease and determine the tactics for further management of the cancer patient;
• septic blockage of blood vessels;
• some systemic pathologies of fibrous connective tissue (Liebman-Sachs disease).

Spinal cord puncture can be used for endolumbar administration of drugs, for example, antibiotics and antiseptics for infectious lesions of the central nervous system or cytostatics (antitumor drugs) for the treatment of various neoplasms. Anesthetics (lidocaine and novocaine) are administered in the same way to perform local anesthesia.

In children under 2 years of age, emergency puncture of the subarachnoid space can be used for febrile syndrome of unspecified origin, provided there is no effect on therapy with antibiotics, glucocorticoids and other first-line drugs used to treat various inflammatory diseases.

Important! Most neuroimaging diagnostic methods completely replace a lumbar puncture, but in some diseases, for example, neuroleukemia, a complete clinical and pathogenetic picture can be achieved by studying the composition and properties of the cerebrospinal fluid.

Contraindications

An absolute and categorical contraindication for performing subarachnoid puncture is the displacement of some segments of the brain relative to other structures, since the introduction of instruments into the subarachnoid space in this case leads to a difference between cerebrospinal pressure indicators in different areas and can cause sudden death the patient directly on the operating table.

Everything is carefully weighed and evaluated possible risks and their relationship with the intended benefit in the presence of the following contraindications, which are considered relative:

• infectious and pustular skin diseases in the lumbar region (furunculosis, carbunculosis, fungal diseases, etc.);
• congenital anomalies, malformations and defects of the spinal tube, central spinal canal and spinal cord;
• impaired blood clotting ability;
• previously performed blockade of the subarachnoid space.

If there are these contraindications, which most neurosurgeons and neurologists consider conditional, the procedure is postponed until the existing restrictions and diseases are eliminated. If this is not possible and diagnosis must be carried out urgently, it is important to consider all possible risks. For example, in case infectious diseases of the skin at the puncture site after puncture, the patient is prescribed antibiotics and antimicrobial agents wide range to prevent infection of internal tissues of the body and the development of inflammatory reactions.

Risks of axial herniation during the procedure

Axial (cerebellar-tentorial) herniation is the descent of the brain into the foramen magnum, which is the natural opening of the skull bones. Clinically, the pathology is manifested by the onset of coma, stiffness of the neck muscles, and sudden cessation of breathing. In the absence of emergency assistance, acute ischemia and hypoxia of brain tissue, and the person dies. To prevent herniation syndrome during the procedure, the doctor uses the thinnest possible needle and takes the minimum required amount of fluid to prevent sudden changes in cerebrospinal pressure.

The maximum risks of axial herniation are observed in the presence of the following pathologies:

• hydrocephalus 3-4 degrees;
• large neoplasms;
• strongly increased performance ICP (difference between cerebrospinal fluid pressure and atmospheric pressure);
• violation of the patency of the liquor-conducting pathways.

In the presence of these four factors, the risk of sudden brain herniation is maximum, therefore these pathologies in most cases are absolute contraindications for lumbar puncture.

How is the procedure done?

The fear experienced by patients who are about to undergo a lumbar puncture procedure may arise against the background of insufficient awareness of the patient about the features of lumbar puncture and a misconception about the procedure for its implementation.

Where is a lumbar puncture performed?

Lumbar puncture is a medical procedure that requires strict adherence to asepsis. For this reason, such manipulations are carried out in the operating room, and the patient is hospitalized for one day in a neurological hospital in the neurosurgery department. It is permissible to perform a puncture in a day hospital: if there are no complications, the patient is sent home 2-4 hours after puncture.

Preparation

Before undergoing the procedure, the patient must sign an informed consent for medical procedures, as well as undergo the necessary examination. The list of mandatory diagnostic minimums before performing lumbar function includes:

• fundus examination (to identify possible symptoms increased intracranial pressure);
• computed tomography of the brain and spinal cord to exclude tumor formations and hydrocephalus;
• general blood test (if platelet deficiency is detected, drug correction is required).

If the patient is taking drugs from the group of anticoagulants (thinning the blood and increasing its fluidity), treatment must be discontinued 72 hours before the scheduled procedure.

Posture for puncturing

The classic and most effective position for a lumbar puncture is considered to be the position when a person lies on the edge of the operating table (on his side), with his legs bent at the hip and knee joints pressed to his stomach. The head should also be tilted forward (the chin extends towards the knees). This position ensures maximum expansion of the interspinous spaces between the vertebrae and facilitates the passage of the needle into the spinal canal.

In some cases, for example, with a large amount of fat in the back area, inserting a needle while lying down is difficult. In such situations, manipulations are carried out in a sitting position: the patient sits on the edge of a table or couch, puts his feet on a special stand, crosses his arms in the chest area and lowers his head on them.

Needle insertion technique

To perform a puncture, a special Beer needle with a rigid rod is used to close holes in tubular instruments (with a mandrel). It is inserted into the space between the spinous processes at the level of L3-L4 or L4-L5. In children, the spinal cord is located slightly lower than in adults, so puncturing for children is performed strictly at the L4-L5 level. The criterion that the needle has reached the subarachnoid space is the feeling of “failure” (the instrument descends into an empty cavity). If everything was done correctly, a clear liquid, cerebrospinal fluid, begins to flow from the needle.

Before puncturing, the skin within a radius of 15-25 cm from the puncture site is treated alcohol solution Yoda. Subarachnoid puncture does not require general anesthesia and is performed under local anesthesia, for which a local anesthetic (most often a 0.25% novocaine solution) is injected at regular intervals while the needle is advanced.

For research, usually from 1-2 ml to 10 ml of cerebrospinal fluid is taken, which is immediately placed in three test tubes, after which its chemical composition, rheological properties, and microbiological parameters are examined.

Risks associated with lumbar puncture

After collecting the cerebrospinal fluid, the puncture site is treated with a 4% solution of colloxylin, diluted in a mixture of ethanol and diethyl ether, and sealed with sterile cotton wool. For 2 hours, the patient should be in a supine position (strictly face down) under the supervision of the doctor who performed the puncture. The patient is prohibited from getting up from the table or couch, turning over on his back, raising his upper body, or dangling his legs. In some institutions, bed rest is prescribed for 24 hours, but in European clinics this approach is considered inappropriate and unjustified, and the patient is sent home within 3-4 hours after the puncture.

What side effects might there be?

Normal side effects that do not indicate poor puncture technique or any complications are:

• headache;
• increased weakness;
• dizziness;
• nausea and vomiting;
• pain in the puncture area and other parts of the back;
• difficulty urinating and defecating.

Such symptoms are part of the post-puncture syndrome complex, can persist for 7-15 hours (less often - up to 1-3 days) and are a consequence of irritation of the spinal cord membranes. Maximum severity similar side effects have in persons with an unstable nervous system and neurological pathologies.

Important! If headaches and other warning signs symptoms that appear immediately after a lumbar puncture, do not go away within 72 hours or intensify a day after the puncture, you must immediately go to the hospital and rule out possible complications.

Risk of complications

Complications after spinal puncture, although rare, do occur. These include:

• epidural hematoma;
• paresis, paresthesia and paralysis of the lower extremities;
• hemorrhage into the subarachnoid space;
• damage to the periosteum of the vertebrae or the musculo-ligamentous apparatus of the spine;
• acute osteomyelitis (purulent inflammation) of the lumbar vertebrae, resulting from violation of aseptic rules;
• bleeding;
• epidermoid cyst.

There are known cases of occurrence intervertebral hernias as a result of damage to the intervertebral discs during needle advancement, therefore, to perform the procedure, it is advisable to use only thin needles up to 8.7 cm long and a mandrel no more than 22 G.

To reduce the risk of complications, it is necessary to behave correctly during the procedure: do not move, try to relax your back muscles as much as possible, and follow other recommendations of the medical staff. After the puncture, it is important to follow a gentle regimen, avoid increased physical activity, do not bend over, do not make sudden movements and do not lift heavy objects. It is important to completely eliminate alcoholic drinks, especially with manifestations of post-puncture syndrome, until your health stabilizes.

Decoding the results

Normally, cerebrospinal fluid has moderate viscosity, a transparent and colorless structure. Even before the analysis, the doctor evaluates the appearance of the cerebrospinal fluid, the presence of impurities in it (for example, blood), the consistency of the liquid and the speed of its flow. Normally, cerebrospinal fluid should be released at a rate of 20 to 60 drops per minute. Deviation from these indicators may indicate inflammatory processes, tumor diseases or metabolic disorders (for example, leukodystrophy).

Normal indicators cerebrospinal fluid and possible abnormalities

Parameter	Norm	The indicator is increased (possible reasons)	The indicator is lowered (possible reasons)
Cerebrospinal fluid density	1,005-1,008	Any inflammatory (including infectious and purulent) diseases of the spinal cord	Excess fluid ( possible signs hydrocephalus)
pH level (acidity)	7,3-7,8	Neurogenic syphilis, epilepsy, organic lesions of the nervous system	Inflammation of the brain and its membranes
Protein	0.44 g/l	Neuroinfections, inflammation of the meninges and various structures of the brain and spinal cord, hydrocephalus, malignant tumors	Neuropathy
Glucose	2.3-4.0 mmol/l	Strokes	Meningitis and meningoencephalitis
Lactic acid salts	1.0-2.5 mmol/l	Inflammation of the brain and its membranes due to infection with pathogenic bacteria and any inflammatory pathologies of the central nervous system	Viral cerebrospinal meningitis
Hydrochloric acid salts	115-135 mmol/l	Neoplasms and accumulation of pus in the cranial cavity	Inflammation of the soft membranes of the brain, neurogenic syphilis, brucellosis

Cloudiness of the cerebrospinal fluid indicates increased infiltration of leukocyte cells, and a dark yellow color indicates possible metastases from skin cancer.

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Spinal cord puncture is an effective therapeutic and diagnostic neurosurgical procedure that has a high degree of reliability and information content in cases of suspected various diseases CNS. Today, sufficient practical experience has been accumulated in carrying out such manipulations, and the risk of possible complications has been minimized, so there is no need to be afraid of a lumbar puncture. All actions are performed under local anesthesia, and the patient does not feel pain during the procedure, except for the initial discomfort from the injection itself.

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If we consider everything existing species diagnostic studies, then spinal cord puncture is rightfully considered one of the most complex research methods. Fluid collection should be performed by a qualified surgeon, exclusively in a hospital setting.

What is a spinal tap

A spinal or lumbar puncture is the collection of cerebrospinal fluid. During the procedure, despite the name, the spinal cord is not affected. For diagnostic studies, it is the cerebrospinal fluid, the fluid surrounding the spinal canal, that is used.

The procedure has certain risks, but when the puncture is performed by a specialist, the likelihood of complications is minimized, and unpleasant symptoms completely disappear in the next few days.

Why is a spinal puncture done?

A spinal puncture is performed if the development of infectious diseases or cancer is suspected. Diagnostic test performed to confirm or clarify the diagnosis.

By collecting cerebrospinal fluid and conducting clinical studies, you can determine:

A spinal tap is taken to measure the pressure in the spinal canal. The procedure may also introduce a marker (in an MRI or CT scan using contrast) or a drug.

Spinal cord puncture is taken for diseases of an infectious and inflammatory nature: purulent meningoencephalitis, meningitis, myelitis, ruptured aneurysms, suspected tumors and hematomas.

An experienced surgeon can determine the patient's condition based on external signs cerebrospinal fluid. At normal pressure, cerebrospinal fluid flows at a rate of 1 drop per minute and is colorless. Any deviations indicate the presence of unfavorable pathological processes.

Preparing for a spinal tap

No special preparation of the patient is required for cerebrospinal fluid puncture. Just inquire about availability allergic reactions for painkillers. During the procedure, local anesthesia is used. The patient is first given an allergy test and only after that proceeds to the procedure itself.

Recently, the question of the need for psychological preparation of a person for cerebrospinal fluid collection has been increasingly raised. Some patients are very worried about the procedure. The specialist’s task is to create a favorable, relaxing atmosphere. It is especially important to create conditions so as not to traumatize the psyche of children.

Is it painful to have a spinal tap?

The procedure for collecting cerebrospinal fluid has been used for about 100 years. Initially, the puncture was done “live”, without the use of anesthetics and therefore was painful. Modern technology for the collection procedure involves the use of local anesthesia.

Although the puncture itself is practically painless, during the puncture the patient will experience some discomfort. The specialist’s task is to warn about this, since during the procedure the patient will need to remain motionless for a certain amount of time.

How to take a puncture

The patient is placed on the couch. The puncture site is injected with anesthetics. After the anesthesia has taken effect, proceed directly to the procedure itself:

• The patient is placed on the couch. The position of the patient during a spinal puncture is as follows: knees pressed to the stomach, chin to the chest. Anatomically, this position of the body leads to the expansion of the processes of the spine and unhindered insertion of the needle.
• The area where the cerebrospinal fluid is collected is disinfected. The area is treated with iodine and alcohol.
• A puncture is performed. There is a special needle for spinal puncture. Its length is 6 cm. The use of reusable needles is not allowed. A spinal tap is taken between the third and fourth vertebrae. In newborns, fluid is collected from the upper part of the tibia.
• The needle is pulled out and the puncture site is sealed with a special plaster.

In specialized clinics, a disposable set of instruments for spinal puncture is used. The instruments include: syringes, disposable needles, napkins for sealing the puncture, sterile gloves and a scalpel.

After the procedure

Collecting fluid for research takes only a few minutes. After a spinal puncture, the patient must be placed on a flat, hard surface. The patient is advised to remain still for the first two hours.

Immediately after the procedure, the following side effects are possible:

• Headaches after a puncture are reminiscent of the sensations that a person experiences during a migraine. Usually accompanied by nausea, sometimes vomiting. Painful sensations are relieved with drugs from the NSAID group.
• Weakness - the body tries to make up for the lack of cerebrospinal fluid, so the patient experiences bouts of lethargy, often accompanied by attacks of pain in the puncture area.

Recovery after puncture takes 2 days. Further hospitalization is prescribed according to indications, taking into account the patient’s well-being.

Why is a spinal tap dangerous?

The danger of collecting a puncture still exists. The patient and the doctor need to soberly assess the situation and possible negative effects due to the procedure.

The following complications and consequences of spinal cord puncture are observed:

• Contact of the anesthetic on the membrane of the spinal cord. Paralysis of the lower extremities develops, and convulsions are observed.
• Increased load on the brain. A contraindication for spinal puncture is massive hemorrhage. The liquid begins to flow out under high pressure. There is a displacement of the brain. As a result, it is infringed nerve center, responsible for the respiratory functions of the body.
• Failure to comply with the conditions of rehabilitation after puncture. Failure to remain in bed for the entire period required for recovery can cause serious complications.

The puncture can be taken no more than once every six months. Experts recommend resorting to this procedure only in extreme cases, when other types of research have failed.

Is it possible to replace a spinal tap with something?

The complex algorithm for performing a spinal puncture and possible complications after the procedure have led to the fact that European clinics rarely resort to this type of research. But to clarify the diagnosis it may be necessary clinical trial liquor, so completely dispense with this diagnostic procedure unreal.

Modern research methods have made it possible to minimize possible risks, discomfort and recovery time after puncture. Therefore, subject to competent medical personnel, collecting fluid is practically safe.

Puncture is a diagnostic medical procedure during which an organ is punctured using a special needle and tissue or fluid is collected for analysis. Also, during the puncture, you can administer medicine or a contrast agent necessary for further research. Patients who are undergoing this manipulation are interested in how the puncture is done and how painful it is.

Why is a puncture done? This question interests many people. In the practice of doctors, these procedures are carried out to diagnose or alleviate the patient’s condition in various pathologies.

Existing types:

• Pleural puncture. It is done in cases where fluid (exudate, blood) accumulates between the pleural sheets.
• Sternal puncture. Such puncturing is performed in patients with suspected diseases of the hematopoietic system (aplastic anemia, leukemia, myelodysplastic syndrome).


• Spinal puncture. Indicated for patients with meningitis, brain tumors, subarachnoid hemorrhage, neuroleukemia.
• Needle biopsy. If you suspect malignant neoplasms and various pathologies, doctors perform biopsies of the lungs, liver, kidneys, thyroid gland, prostate, ovaries and others internal organs.
• Cordocentesis. A puncture of the umbilical vein, during which fetal blood is taken for analysis. This allows us to identify anemia that is dangerous for the child viral diseases(toxoplasmosis) and isolate cells for chromosomal analysis.
• Puncture of the maxillary sinuses. Performed for sinusitis in order to remove stagnant exudate, blood or pus from the maxillary sinuses.

The follicle is punctured separately. It involves the collection of eggs, which are subsequently used during the in vitro fertilization procedure in infertile couples.

How is a pleural puncture performed?

In what situations is pleural puncture performed? Manipulation is indicated for conditions that are accompanied by the accumulation of excess fluid between the parietal and visceral pleural layers.

This occurs when:

• Lung tumors.
• Tuberculous lesions of the pleura and lungs.
• Heart failure.
• Bleeding.
• Empyema of the pleura and pleurisy after pneumonia.

Only an experienced surgeon or anesthesiologist should perform a puncture of the pleura, since during manipulation there is a risk of damage to the lungs or large vessels. To carry out this type of puncture, patients first undergo an ultrasound of the chest to accurately determine the fluid level.

To perform the manipulation, a large thick needle with a diameter of 2 mm and a length of 100 mm is used. Using a rubber guide, the needle is connected to a syringe or container for collecting pathological fluid. During the procedure, to prevent gas bubbles from entering the pleural cavity, the rubber tube is periodically pinched with forceps.

The step-by-step technique of the procedure is as follows:

1. Before the puncture, the doctor treats the skin in the area of ​​the 7–8 intercostal spaces along the posterior scapular line with an antiseptic solution.
2. Fills a two-cc syringe with 0.5% novocaine.
3. He pierces the skin and, gradually introducing the anesthetic, slowly inserts the needle until a sensation of “failure” is felt.
4. After which, he pulls the piston and uses it to extract pathological contents - blood, exudate, purulent masses.
5. Then the specialist changes the needle to a puncture needle and connects it to an electric suction device to begin the process of pumping out the exudate.

As a rule, the procedure is performed not only for diagnostic purposes, but also for treatment. During this procedure, a small amount of liquid is taken for analysis, the excess is pumped out, and the pleural cavity is washed with medicinal solutions.

When answering the question “does it hurt to do a puncture,” it is important to know that during the procedure a local anesthetic solution is used, which reduces pain to a minimum.

Typically, patients experience minor discomfort 30–50 minutes after the procedure, when the local anesthesia wears off.

Puncture for pneumothorax

Separately, pleural puncture is performed for pneumothorax, a condition that is accompanied by the accumulation of gas in the pleural cavity and compression of the lungs.

This emergency. If excess gas is not quickly removed, the lung will collapse and lose its function. In this case, pleural puncture is performed using a regular needle in the 2nd intercostal space along the midclavicular line.

It is important to remember that when puncturing the pleura, the needle must be inserted strictly along the upper surface of the lower rib (in the case of pneumothorax, this is the third rib). This precaution will avoid accidental damage to the intercostal arteries.

Needle biopsy

A puncture and biopsy of internal organs is most often performed when malignant neoplasms or purulent processes are suspected.

Otorhinolaryngologists in their practice often encounter peritonsillar abscesses, the treatment of which consists of opening and draining the abscess. In order to get rid of such an abscess, the doctor injects the patient’s tonsils and the area around them with a local anesthetic, for example, novocaine, then uses a special needle to aspirate the purulent masses and rinses the cavity with Furacilin solution.

Patients are interested in whether it hurts to take a puncture? Typically, puncture of a peritonsillar abscess is not accompanied by unpleasant sensations On the contrary, after it is carried out, patients experience relief.

Puncture of the maxillary sinus

Why do they take a puncture from the maxillary sinus? This procedure is done for recurring sinusitis that does not respond to conservative treatment with antibiotics. It can also be used to detect tumors and determine the conductivity of the anastomosis in the maxillary sinus.

The procedure is simple, it can be done in the manipulation room or directly in the ENT doctor’s office. Before the puncture, the nasal cavity is toileted and the mucous membrane is treated with a mixture of adrenaline and lidocaine.

• A special Kulikovsky needle is inserted at a distance of 2 cm from the inferior turbinate. In this case, its tip should be turned towards the outer corner of the eye on the affected side.
• After making a puncture and feeling a “failure,” the needle is inserted 5 mm deep into the sinus.
• The sinus is washed with antiseptics and antibiotic solution.

Puncture of the maxillary sinus is simple and effective, but quite painful method treatment, which serves only as an addition to antibiotic therapy for sinusitis.

What it is? Puncture is a medical procedure for puncturing an organ or its cavity with a needle for therapeutic and diagnostic purposes. There are two types of puncture:

1. Diagnostic. The organ is pierced and a part is taken away biological material For example, during a lumbar puncture (puncture of the spinal cord), cerebrospinal fluid is collected and sent for laboratory testing to study its properties.
2. Therapeutic. The goal is to improve the patient's condition. For example, in case of hypertensive syndrome, a puncture of the ventricles of the brain is performed. Some of the liquid is withdrawn. This lowers intracranial pressure and brings relief to the patient. In the 19th century and the beginning of the 20th, vascular puncture was done - bloodletting for arterial hypertension. Now it is irrelevant.

The puncture may be independent method diagnostics and treatment, and used in combination with other methods. For example, the puncture can be carried out under control ultrasound examination. The brain is displayed on the monitor, where a cyst is detected. In real time, a needle is inserted into the cyst. The combination of methods provides high accuracy and safety of the procedure.

A puncture within the central nervous system is done for the brain and spinal cord.

A brain puncture is prescribed when there is suspicion of the presence of pus. Frequent localizations of purulent formation:

• inferior frontal lobes;
• temporal region;
• middle ear;
• mastoid region.

The technology for puncturing the brain depends on the location of the pathological process. How the brain is pierced if access to the anterior horns of the lateral ventricles is needed:

1. The patient lies on his back. The head bows to the chest.
2. The injection site is determined. It is disinfected with iodine twice.
3. Estimate the puncture point by applying a marker with brilliant green.
4. Local anesthesia is administered.
5. The skin is cut with a scalpel. In the same place, a hole is made in the skull, which is called a trepanation window.
6. Having gained access to the brain, the surgeon makes a cross-shaped incision in the dura mater. An anticoagulant is immediately administered to prevent bleeding.
7. A cannula 6 cm deep is inserted. It is inserted parallel to the incision. When the surgeon enters the cavity, he feels a failure.
8. Liquid begins to flow through the hole. Its color, density and smell depend on the nature of the inflammation or neoplasm. For example, when purulent inflammation the liquid has an unpleasant odor and green color, flows out slowly. Intracranial pressure is judged by the rate of fluid release: the higher it is, the faster the pus flows out. Thus, at high pressure the liquid can flow.

A liquid volume of 5 ml is taken. It is sent to the laboratory, and the surgeon cleans the intervention area and sutures the skin.

How to take liquid from posterior horns lateral ventricles:

• The patient takes a supine position on his stomach. The head is positioned so that the sagittal suture runs along the midline.
• The preparation is the same as for puncture of the anterior horns.
• The skin is cut parallel to the seam. The surgeon takes the needle and inserts it at an angle. Typically, the maximum puncture depth reaches 3 cm.
• The technology for collecting material and the final stage repeats the technique of puncture of the anterior horns.

The puncture of the spinal cord is called a lumbar puncture. The needle is inserted into the subarachnoid space in the spinal cord at the lumbar level. The purpose of the puncture is to study the parameters of cerebrospinal fluid or to administer spinal anesthesia.

How the spinal cord is pierced:

1. The patient lies or sits. If in a supine position, the patient is placed on his side. The legs are bent and brought towards the stomach. The back is bent as much as possible, and the hands clasp the knees.
2. The doctor palpates the spine: he looks for the gap between the third and fourth lumbar vertebrae. This choice is determined by the fact that this location is least likely to damage the spinal cord. For children, the spinal cord is pierced below the third lumbar vertebra.
3. A puncture of the spinal cord brings a lot of pain, so the patient is given local anesthetic. Usually a 2% solution of novocaine with a volume of 7-8 ml is used.
4. A Bier needle is inserted between the protruding parts of the vertebrae. It is inserted with an upward slope. Gradually it is pushed deeper. The surgeon will feel the support - these are the spinal ligaments. After puncturing them (approximately at a depth of 5-6 cm, in children - 2 cm), the doctor will feel a failure - it has entered the spinal canal.
5. After the needle is removed, cerebrospinal fluid begins to flow out - this is a sign that the procedure was performed correctly. It happens that the needle sticks into the bone. In this case, the doctor repeats the procedure again until he reaches the spinal canal.
6. After taking the fluid, the patient should lie on his stomach for two hours. The puncture is sealed with a sterile napkin.

After the procedure, pain is usually felt at the puncture site in response to a decrease in pressure inside the skull. It goes away on average within 5 days.

Indications

A puncture of the brain with a needle is carried out for the following indications:

• Neuroinfections and inflammatory diseases brain
• Neurosyphilis, meningeal tuberculosis.
• Hemorrhagic stroke, hemorrhage in the ventricles of the brain and subarachnoid space.
• Traumatic brain injury accompanied by swelling.

Why is a lumbar puncture done:

1. Confirm or deny the presence of a neuroinfection, for example, or.
2. Administer an antibiotic or chemotherapy drug.
3. Reduce intracranial pressure.

Contraindications

An absolute contraindication for puncture of the spinal cord and brain is suspected or confirmed dislocation syndrome, in which brain structures are displaced. A sudden decrease in intracranial pressure will displace parts of the brain, which can cause an emergency such as respiratory or cardiac arrest.

Possible complications

Possible complications after puncture of the brain and spinal cord:

• Displacement of structures, which causes dislocation syndrome.
• Cholesteatoma is the formation of a cavity in the spinal cord that contains dead epithelial cells.
• Bleeding.
• Headache, nausea, dizziness.

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Classmates

Lumbar puncture of the spinal cord (lumbar puncture, spinal, lumbar or spinal tap) is carried out in the lower back, in the area lumbar level spine. During the operation, a medical needle is inserted between two lumbar bones spine(s) to either obtain a sample of cerebrospinal fluid, or to numb the area for therapeutic or anesthetic purposes, or to carry out therapeutic measures.

The procedure allows specialists to detect dangerous pathologies:

• meningitis;
• neurosyphilis;
• abscess;
• various central nervous system disorders;
• multiple demyelinating sclerosis;
• all kinds of cancer of the brain and spinal cord.

Doctors sometimes use a lumbar puncture to administer pain medications during chemotherapy.

• selection of cerebrospinal fluid for research;
• determining the pressure in the cerebrospinal fluid;
• performing spinal anesthesia;
• administration of chemotherapy drugs and medicinal solutions;
• performing myelography and cisternography.

When performing a spinal cord puncture for the above procedures, a pigment solution or radioactive composition is injected into the patient using an injection to obtain a clear image of the fluid jet.

The information collected during this procedure allows you to discover:

• dangerous microbial, viral and fungal infections, including encephalitis, syphilis and meningitis;
• hemorrhage into the subarachnoid space of the brain (SAH);
• some types of cancer that arise in the brain and spinal cord;
• most inflammatory conditions of the central nervous system, e.g. multiple sclerosis, acute polyradiculitis, various paralysis.

Risks and consequences of lumbar puncture

Lumbar puncture of the spine is a dangerous procedure. Only a person can take a puncture correctly qualified doctor with special tools and deep knowledge.

Manipulation in the spine area can have negative consequences. They can lead to:

Where does the needle go to take cerebrospinal fluid?

• headache;
• discomfort;
• bleeding;
• increased intracranial pressure;
• hernia formation;
• the development of cholesteatoma - a tumor-like formation containing dead epithelial cells and a mixture of other substances.

Quite often, after performing a lumbar puncture, patients experience severe headache. Malaise occurs due to fluid leakage into nearby tissues.

Patients often notice headaches while sitting or standing. It often goes away when the patient goes to bed. Considering the current picture, attending physicians recommend leading a sedentary lifestyle and bed rest for the first 2-3 days after surgery.

Persistent pain in the spine is a common complaint experienced by patients undergoing spinal cord puncture. The pain may be localized at the puncture site and spread down along the back of the legs.

Main contraindications

Lumbar puncture of the spinal cord is strictly contraindicated in patients in whom brain dislocation is suspected or has already been identified, or the presence of brainstem symptoms has been detected.

A drop in cerebrospinal fluid pressure in the spinal volume (in the presence of a lesion high blood pressure) may have dangerous consequences. It can trigger the mechanisms of infringement of the brain stem and thereby provoke the death of the patient in the operating room.

Special precautions should be taken when performing a puncture in patients with bleeding disorders, people prone to bleeding, and also taking blood thinning medications (anticoagulants). These include:

• warfarin;
• clopidogrel;
• some commercial analgesics such as aspirin, ivalgin or naproxen sodium.

How is a puncture performed?

A lumbar puncture can be performed in a clinic or in a hospital. Before the procedure, the patient’s back is washed with antiseptic soap, disinfected with alcohol or iodine and covered with a sterile napkin. The puncture site is disinfected with an effective anesthetic.

This puncture is made between the third and fourth or fourth and fifth spinous processes of the spine. The guideline of the interspinous space is the curve that outlines the vertices iliac bones spine.

Standard puncture site in the spine

The patient who will undergo the procedure is laid horizontally on the couch (on the left or right side). His bent legs are pressed to his stomach, and his head is pressed to his chest. Skin covering the puncture area is treated with iodine and alcohol. The puncture site is numbed by subcutaneous injection of novocaine solution.

During the period of anesthesia, the doctor punctures the intrathecal space with a medical needle with a mandrel 10-12 cm long and 0.5-1 mm thick. The doctor should insert the needle strictly in the sagittal plane and direct it slightly upward (corresponding to the imbricated location of the spinous formations).

As the needle approaches the intrathecal space, it will experience resistance from the contact of the interspinous and yellow ligaments, easily overcome the layers of epidural fatty tissue and encounter resistance when passing through the strong meninges.

At the moment of puncture, the doctor and patient may feel like the needle is falling through. This is quite normal phenomenon, which is not something to be afraid of. The needle should be advanced along the course by 1-2 mm and the mandrel should be removed from it. After removing the mandrin, cerebrospinal fluid should flow out of the needle. Normally, the liquid should have a transparent color and flow out in scanty drops. Modern manometers can be used to measure pressure in the cerebrospinal fluid.

Drawing out cerebrospinal fluid with a syringe is strictly prohibited, as this can lead to dislocation of the brain and pinching of the brainstem.

After determining the pressure and taking the cerebrospinal fluid, the syringe needle must be removed and the puncture area must be sealed with a sterile pad. The procedure lasts approximately 45 minutes. After the puncture, the patient must stay in bed for at least 18 hours.

What happens after the procedure

Patients are prohibited from performing active or strenuous work on the day of the procedure. The patient will be able to return to normal life only after the doctor’s permission.

The fluid sample removed by puncture is placed in a box and delivered to the laboratory for analysis. As a result of research activities, the laboratory assistant finds out:

What should the cerebrospinal fluid readings be? A good result is characterized by a clear, colorless liquid. If the sample has a dull, yellowish or pinkish tint, this indicates an infection.

The protein concentration in the sample is studied (the presence total protein and specific proteins). An increased protein content indicates poor health patient, the development of inflammatory processes. If the protein level is above 45 mg/dl, then infections and destructive processes may be present.

The concentration of white blood cells is important. The sample should normally contain up to 5 mononuclear leukocytes (white blood cells). An increase in the number of white blood cells indicates the presence of infection.

Attention is paid to the concentration of sugar (glucose). A low sugar level in a collected sample confirms the presence of infection or other pathological conditions.

The detection of germs, viruses, fungi or any microorganisms indicates the development of an infection.

Finding cancerous, malformed, or immature blood cells confirms the presence of some type of cancer.

Laboratory tests allow the doctor to determine accurate diagnosis diseases.

To examine the patient, specialists use various diagnostic methods. One of them is spinal cord puncture, otherwise called lumbar puncture.

This is a serious and rather complex process in which spinal cord fluid is taken. This procedure has some risks, and therefore it is used relatively rarely.

What is the procedure

Cerebrospinal fluid is collected in order to confirm the suspected diagnosis or to identify associated complications. We propose to consider the most common situations requiring this procedure:

• infectious diseases of various types;
• inflammatory processes occurring in the spinal cord or brain;
• the presence of bone tissue compactions;
• determination of spinal cord fluid pressure;
• suspected tumor.

Why else is a spinal puncture done? In addition to the situations that we have listed, the procedure can be performed for medicinal purposes. For example, thanks to puncture it is possible to enter medications and thus save the patient from intervertebral hernias.

A patient after a stroke may also undergo a spinal puncture. This will help clarify the nature of the stroke.

However, before puncturing, the patient will be informed about the risk of the procedure, so it will be performed only in the most extreme cases.

Technique

We have looked at why a puncture is taken from a vertebra; now we suggest finding out exactly how this procedure is carried out:

• Puncture in the supine position. This position of the patient is most convenient for the specialist, so it is used much more often. The patient is placed on a hard surface on his side. He bends his legs to his stomach, presses his chin to his chest, and sucks in his stomach. This position allows you to stretch the spine as much as possible, which helps to achieve an increased distance between the vertebrae. The cerebrospinal fluid is collected in the presence of a nurse. There are situations when the doctor asks the nurse to fix the patient in the required position before inserting the needle. This allows the specialist to be confident that the patient will not change his position due to the unexpected sensation of a needle puncture. After the doctor inserts the needle, the patient can slowly change his position, but so that it does not interfere with the favorable course of the procedure.
• Puncture in a sitting position. The patient is seated on a gurney, and the patient must hold onto it with his hands. The nurse holds him, and she needs to monitor the patient’s condition, taking into account his autonomic reaction.

Before performing the procedure, the doctor first palpates the puncture site, feeling the required vertebrae and the distance between them. The intended puncture site is treated with a three percent iodine solution and a 70% ethyl alcohol solution. These products are applied from the center to the periphery.

As for pain relief, 4 to 6 milliliters of a two percent solution of novocaine or another anesthetic, which is administered during the future puncture, is sufficient. It is worth noting that many doctors prefer lidocaine to collect spinal cord fluid.

Local anesthesia is also given to patients with impaired consciousness. This is due to the fact that the lungs painful sensations may provoke an unwanted motor reaction.

Before carrying out the procedure, the specialist must check the site of the intended puncture several times and also make sure that the needle is in good working order. The course of the needle during puncture of the intervertebral disc should resemble the position of a pen when writing.

For children younger age the direction of the needle is perpendicular to the plane being punctured. As for adults, the needle is inserted with a slight inclination, taking into account the overhang of the spinous vertebrae.

Possible complications

Any interference with the natural functioning of the body entails certain risks and can lead to various complications. Some patients complain that their spine hurts after the puncture. Patients often report the following symptoms:

• nausea;
• headache;
• dizziness;
• vomit;
• general weakness.

Some experts are inclined to believe that two to three hours in a prone position is quite enough and after this time the patient can move freely. This will significantly reduce the risk of developing undesirable consequences.

It is also worth noting that some patients may experience severe pain. In such cases, the doctor will prescribe an effective pain reliever.

Another complication may be infection during the collection of spinal cord fluid. But if the procedure is carried out under sterile conditions, then the risk of infection is practically absent.

Doctors often encounter patients' fears that the spinal cord will be affected during the collection of cerebrospinal fluid. We hasten to dispel these misconceptions. The puncture is taken in the lumbar spine, just below the spinal cord itself. In this regard, it is not possible to touch him.

It is fair to say that today there are far fewer dangerous ways diagnosis than spinal cord puncture.

Therefore, if possible, doctors will use CT, MRI or ultrasound. But, unfortunately, there are diagnoses that only require a puncture to confirm. In this case, strictly follow all doctor’s recommendations and stay healthy!

Denial of responsibility

The information in the articles is for general information purposes only and should not be used for self-diagnosis of health problems or for therapeutic purposes. This article is not a substitute for medical advice from a doctor (neurologist, therapist). Please consult your doctor first to know the exact cause of your health problem.

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Spinal cord puncture. Such a terrible phrase can often be heard at a doctor’s appointment, and it becomes even scarier when this procedure concerns you specifically. Why do doctors puncture the spinal cord? Is such manipulation dangerous? What information can be obtained from this study?

The first thing you need to understand when it comes to spinal cord puncture (which is what patients most often call this procedure), it does not mean a puncture of the tissue of the central nervous system organ itself, but only the collection of a small amount of cerebrospinal fluid, which washes the spinal cord and brain . Such manipulation in medicine is called a spinal, or lumbar, puncture.

Why is a spinal cord puncture performed? There can be three purposes of such manipulation - diagnostic, analgesic and therapeutic. In most cases, a lumbar puncture of the spine is done to determine the composition of the cerebrospinal fluid and the pressure inside the spinal canal, which indirectly reflects pathological processes occurring in the brain and spinal cord. But specialists can perform a spinal cord puncture for therapeutic purposes, for example, to administer medications into the subarachnoid space to quickly reduce spinal pressure. Also, do not forget about such a method of pain relief as spinal anesthesia when anesthetics are injected into the spinal canal. This makes it possible to perform a large number of surgical interventions without the use of general anesthesia.

Considering that in most cases, spinal cord puncture is prescribed specifically for diagnostic purposes, it is this type of study that is discussed we'll talk In this article.

Why is a puncture taken?

A lumbar puncture is taken to examine the cerebrospinal fluid, which can help diagnose some diseases of the brain and spinal cord. Most often, such manipulation is prescribed for suspected:

• infections of the central nervous system (meningitis, encephalitis, myelitis, arachnoiditis) of a viral, bacterial or fungal nature;
• syphilitic, tuberculous lesions of the brain and spinal cord;
• subarachnoid bleeding;
• abscess of the central nervous system;
• ischemic, hemorrhagic stroke;
• traumatic brain injury;
• demyelinating lesions of the nervous system, such as multiple sclerosis;
• benign and malignant tumors of the brain and spinal cord, their membranes;
• Guienne-Barré syndrome;
• other neurological diseases.

Contraindications

It is prohibited to take a lumbar puncture for space-occupying formations of the posterior cranial fossa or temporal lobe of the brain. In such situations, taking even a small amount of cerebrospinal fluid can cause dislocation of brain structures and cause strangulation of the brain stem in the foramen magnum, which entails immediate death.

It is also prohibited to perform a lumbar puncture if the patient has purulent-inflammatory lesions of the skin, soft tissues, or spine at the puncture site.

Relative contraindications are severe spinal deformities (scoliosis, kyphoscoliosis, etc.), since this increases the risk of complications.

With caution, puncture is prescribed to patients with bleeding disorders, those who take drugs that affect blood rheology (anticoagulants, antiplatelet agents, non-steroidal anti-inflammatory drugs).

Preparation stage

The lumbar puncture procedure requires preliminary preparation. First of all, the patient is prescribed general clinical and biochemical tests blood and urine, the state of the blood coagulation system is necessarily determined. Carry out inspection and palpation lumbar region spine. To identify possible deformations that may interfere with the puncture.

You need to tell your doctor about all the medications you are currently taking or have recently taken. Particular attention should be paid to drugs that affect blood clotting (aspirin, warfarin, clopidogrel, heparin and other antiplatelet agents and anticoagulants, non-steroidal anti-inflammatory drugs).

You should also tell your doctor about possible allergies for medications, including anesthetics and contrast agents, about recent acute diseases, about the presence of chronic ailments, since some of them may be a contraindication to the study. All women of childbearing age should tell their doctor if they may be pregnant.

It is forbidden to eat for 12 hours before the procedure and drink for 4 hours before the puncture.

Puncture technique

The procedure is performed with the patient lying on his side. In this case, you need to bend your legs as much as possible at the knees and hip joints, bring them to the stomach. The head should be bent forward as much as possible and close to chest. It is in this position that the intervertebral spaces widen well and it will be easier for the specialist to get the needle into the right place. In some cases, the puncture is performed with the patient sitting with the back as rounded as possible.

The specialist selects the puncture site by palpating the spine so as not to damage the nerve tissue. The spinal cord in an adult ends at the level of the 2nd lumbar vertebra, but in short people, as well as in children (including newborns), it is slightly longer. Therefore, the needle is inserted into the intervertebral space between the 3rd and 4th lumbar vertebrae or between the 4th and 5th. This reduces the risk of complications after puncture.

After skin treatment antiseptic solutions local infiltration anesthesia of soft tissues is performed with a solution of novocaine or lidocaine using a regular syringe with a needle. After this, a lumbar puncture is performed directly with a special large needle with a mandrel.

The puncture is made at the selected point, the doctor directs the needle sagittally and slightly upward. At approximately a depth of 5 cm, resistance is felt, after which a peculiar dip of the needle follows. This means that the end of the needle has entered the subarachnoid space and you can begin collecting cerebrospinal fluid. To do this, the doctor removes the mandrin (the inner part that makes the instrument airtight) from the needle and cerebrospinal fluid begins to drip from it. If this does not happen, you need to make sure that the puncture is performed correctly and that the needle enters the subarachnoid space.

After collecting the cerebrospinal fluid into a sterile tube, the needle is carefully removed and the puncture site is sealed with a sterile bandage. For 3-4 hours after the puncture, the patient should lie on his back or side.

Cerebrospinal fluid examination

The first step in cerebrospinal fluid analysis is to assess its pressure. Normal values ​​in a sitting position are 300 mm. water Art., in a lying position – 100-200 mm. water Art. As a rule, pressure is assessed indirectly - by the number of drops per minute. 60 drops per minute corresponds to the normal value of cerebrospinal fluid pressure in the spinal canal. Pressure increases during inflammatory processes of the central nervous system, with tumor formations, with venous stagnation, hydrocephalus and other diseases.

Next, the cerebrospinal fluid is collected into two 5 ml tubes. They are then used to carry out the necessary list of studies - physicochemical, bacterioscopic, bacteriological, immunological, PCR diagnostics, etc.

Consequences and possible complications

In the vast majority of cases, the procedure takes place without any consequences. Naturally, the puncture itself is painful, but pain is present only at the stage of inserting the needle.

Some patients may develop the following complications.

Post-puncture headache

It is generally accepted that after a puncture a certain amount of cerebrospinal fluid flows out of the hole, as a result of which intracranial pressure decreases and a headache occurs. This pain resembles a tension headache, has a constant aching or squeezing character, and decreases after rest and sleep. It can be observed for 1 week after the puncture; if cephalgia persists after 7 days, this is a reason to consult a doctor.

Traumatic complications

Sometimes traumatic complications of puncture can occur, when the needle can damage spinal nerve roots and intervertebral discs. This is manifested by back pain, which does not occur after a correctly performed puncture.

Hemorrhagic complications

If large blood vessels are damaged during the puncture, bleeding and hematoma formation may occur. This is a dangerous complication that requires active medical intervention.

Dislocation complications

Occurs when there is a sharp drop in cerebrospinal fluid pressure. This is possible in the presence of space-occupying formations in the posterior cranial fossa. To avoid such a risk, before taking a puncture, it is necessary to perform a study for signs of dislocation of the midline structures of the brain (EEG, REG).

Infectious complications

They may occur due to violation of the rules of asepsis and antisepsis during puncture. The patient may develop inflammation of the meninges and even form abscesses. Such consequences of puncture are life-threatening and require the prescription of powerful antibacterial therapy.

Thus, spinal cord puncture is a very informative technique for diagnosing a large number of diseases of the brain and spinal cord. Naturally, complications during and after the manipulation are possible, but they are very rare, and the benefits of puncture far outweigh the risk of developing negative consequences.

Puncture is a specific procedure that is used to diagnose pathologies, as well as treat internal organs and biological cavities. It is done using special needles and other devices. Before agreeing to such a procedure, it is necessary to take a closer look at what a puncture is, what features it has and how it is performed.

general description

A puncture is a special puncture of the tissues of internal organs, blood vessels, various neoplasms, cavities for collecting fluids for the purpose of diagnosing pathologies. In addition, the use of the procedure in some cases is necessary for the administration of medications. It is used to diagnose pathologies of the liver, bone marrow, lungs, and bone tissue. Basically, in this way they are determined oncological diseases. To clarify the diagnosis, materials are taken directly from the tumor. As for the blood vessels, they are punctured for sampling biological fluid, installation of catheters through which medications are administered. Parenteral nutrition is also performed in the same way.

If in the abdominal, articular or pleural cavity observed inflammatory process accompanied by accumulation of fluid or pus, then puncture is used to remove this pathological content. For example, using this procedure, drains are installed for flushing internal organs and administering medications.

Indications for use of the procedure in gynecology

So, to use a puncture puncture there must be appropriate indications. They do it in order to:

• confirm ectopic pregnancy or infertility due to female factor;
• determine the presence of a rupture of the uterus or other internal organs;
• exclude peritonitis;
• counting the number of oocytes in the ovaries;
• determine the amount and nature of exudate in the organ cavity, tumors;
• diagnose internal endometriosis, cysts, as well as other neoplasms of a malignant or benign nature;
• determine the violation menstrual cycle, uterine bleeding of unspecified origin;
• diagnose or exclude developmental anomalies reproductive organs women;
• collect material to determine the effectiveness of the treatment;
• collect eggs during the IVF procedure.

Types of puncture in gynecology

There are several types of punctures that are used for the diagnosis and treatment of female diseases:

1. Breast puncture. It is prescribed in the presence of nodules, ulcers or any lumps, changes in skin tone, or strange discharge from the nipples. The procedure allows you to determine the presence of tumors of different etiologies and diagnose their nature. Some preliminary preparation is required. For example, a week before the puncture you should not take Aspirin or any other medications, helping to reduce blood clotting. After the puncture, a woman may feel slight discomfort, which goes away after a few days.
2. Retrieval of eggs for artificial insemination. The procedure should be carried out 35 hours after the injection of human chorionic gonadotropin. The puncture is performed transvaginally. A special needle is also required. The entire process is controlled by ultrasound. This procedure requires certain skills, so you need to look for an experienced specialist for this. In general, it is considered practically painless, but in order to avoid complications after the puncture, the woman is given anesthesia.
3. Cardocentesis. This procedure is important for determining congenital pathologies or infectious lesions of the fetus. To do this, blood is taken from the umbilical cord. It is allowed from the 16th week, but in order not to harm the baby and to get a more accurate result, a puncture is prescribed from 22 to 24 weeks. A puncture is made through the pregnant woman's abdomen into the umbilical cord vessel. All devices must be sterile. For puncture, a special needle with an attached syringe is taken. This method of determining infection or developmental abnormalities is considered the most accurate, but is used only if other diagnostic methods are ineffective.
4. Ovarian cyst puncture. This procedure is used diagnostically as well as therapeutic purpose. The procedure requires general anesthesia, which is administered intravenously. The instruments are inserted through the vagina. The needle enters through a special sensor. An aspirator is attached to it. The instrument is used to suction fluid from the cyst cavity. The biomaterial is sent to the laboratory for cytological and histological analysis. After there is no more fluid left in the cyst, a small amount of alcohol is injected into it, gluing the walls of the formation. In most cases, this procedure allows you to completely get rid of the cyst, although in rare cases relapses are possible. After the puncture, the woman returns home on the second day. In general, the manipulation does not cause pain, however, the patient must be completely motionless, so anesthesia is necessary.
5. Puncture abdominal cavity. It is carried out through its wall or posterior vaginal fornix. The procedure is used to diagnose gynecological pathologies, as well as to prepare for surgery. Since such a puncture is very painful, it must be performed with anesthesia. Moreover, anesthesia can be local or general. Before performing a puncture, the intestines and bladder should be empty.

General rules for puncture

Many women are interested in how a puncture is performed. In most cases, it is painless. However, in order for the procedure to take place without complications, as well as for the psychological comfort of the woman, anesthesia or pain relief is necessary. There are other rules for performing a puncture:

1. Before the procedure, all instruments, as well as the external genitalia, must be treated with a disinfectant solution. This will avoid additional infection of internal tissues and cavities.
2. If the puncture is made through the back wall of the vagina, then the movement should be sharp and light. At the same time, care must be taken not to damage the wall of the rectum.
3. If there is very thick exudate in the cyst or cavity, which can clog the needle, it is necessary to inject a sterile solution inside.
4. Puncture is permitted only in specialized clinics or medical offices.

Possible consequences

In general, the diagnostic operation is painless, but sometimes the following consequences of the puncture can be observed:

• injury to blood vessels or the endometroid layer of the uterus;
• decreased blood pressure (during operations involving serious blood loss);
• inflammatory process in the organ or cavity in which the puncture is performed;
• damage to the rectum (often no additional treatment is required);
• general deterioration of health;
• dizziness;
• scanty vaginal discharge;
• dull pain in the abdominal area;
• incorrect diagnosis (blood in the fluid may appear not as a result of the disease, but due to damage to the vessels located in the periuterine tissue).

Puncture in gynecology is a frequently used tool for diagnosing and treating pathologies of the reproductive system. It can only be done as prescribed by a doctor in a medical facility.

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