Today there are many techniques that can be used to diagnose various diseases. One of them is puncture spinal cord. Thanks to this procedure, it is possible to identify such dangerous diseases, such as meningitis, neurosyphilis, cancerous tumors.
Lumbar puncture is performed in the area lumbar region. To receive a sample cerebrospinal fluid a special needle is inserted between two vertebrae. In addition to diagnostic purposes, the puncture can be performed to introduce medicines, for pain relief. The procedure is not always safe. Therefore, you need to know all the contraindications and possible complications before carrying out the procedure.
Goals and indications for the study
CSF (cerebrospinal fluid) is taken from the subarachnoid space; the spinal cord remains untouched during the procedure. Studying the material makes it possible to obtain information about a particular disease and prescribe the correct treatment.
Purposes of lumbar puncture:
- laboratory examination of cerebrospinal fluid;
- reducing pressure in the brain and spinal cord by removing excess fluid;
- measurement of cerebrospinal fluid pressure;
- administration of medications (chemotherapy), contrast agents (for myelography, cisternography).
More often, the study is prescribed to those patients who presumably have the following pathologies:
- CNS infections (encephalitis, meningitis);
- abscess;
- inflammation in the spinal cord and brain;
- ischemic stroke;
- skull injuries;
- tumor formations;
- bleeding in the subarachnoid space;
- multiple sclerosis.
For therapeutic purposes, lumbar puncture is often used to administer medications. Given the certain danger of the procedure for the patient, it is recommended to perform it only in cases where it is absolutely necessary.
Contraindications
Cerebrospinal fluid sampling is not performed in case of large formations of the posterior fossa of the skull or temporal region brain Such a procedure for these pathologies can cause pinching of the brain stem in the foramen of the head and lead to death.
A puncture cannot be performed if a person has purulent inflammation skin, spinal column at the site of the intended puncture. There is a high risk of complications after the procedure with obvious spinal deformities (,). The puncture should be performed very carefully in case of problems with blood clotting, as well as in people taking certain medications (Aspirin,), anticoagulants (Warfarin, Clopidogrel).
Special preparatory activities before lumbar puncture does not exist. Before the procedure, patients undergo allergy tests to determine their tolerance to the injected painkillers. Before collecting cerebrospinal fluid, local anesthesia is required.
On a note! Since for many people being studied the upcoming procedure is stressful, there is often a need for psychological preparation. An experienced specialist must create an atmosphere in which the patient feels relaxed and calm. This is especially important if the patients are children.
Process
The patient is placed on the couch on his side. Your knees should be pressed towards your stomach. Press your chin as close to your chest as possible. Thanks to this position, the processes of the spinal column move apart, the needle can be inserted without hindrance.
The area where the needle is inserted should be well disinfected with alcohol and iodine. Then an anesthetic (usually Novocaine) is injected. While the puncture is being performed, the patient should lie still. For the procedure, a disposable sterile 6-centimeter needle is taken, which is inserted at a slight angle. The puncture is made between the 3rd and 4th vertebrae below the level of the end of the spinal cord. In newborns, cerebrospinal fluid is taken from the upper part of the tibia.
If cerebrospinal fluid is taken for diagnostic purposes, only 10 ml is sufficient. A monometer is attached to the needle, which measures the intracerebral pressure of the cerebrospinal fluid. U healthy person the liquid is transparent, flows out in 1 second in a volume of 1 ml. At high blood pressure this speed increases.
The pick-up lasts up to half an hour. The specialist monitors the progress of the procedure using fluoroscopy. After the required amount of liquid has been taken, the needle is carefully removed and a patch is applied to the puncture site.
After the procedure
After the manipulation, the person must lie down on a flat, hard surface and lie motionless for 2 hours. You cannot get up or sit during the day. Then for 2 days you need to stay in bed and drink as much fluid as possible.
Immediately after collecting the material, the patient may feel headaches resembling a migraine. They may be accompanied by nausea or vomiting. As the body recovers from the lack of cerebrospinal fluid, attacks of lethargy and weakness occur. There may be pain in the puncture area.
On the page read about characteristic symptoms And effective methods treatment of back muscle strain.
CSF examination
When analyzing a liquid, its pressure is first assessed. The norm in a sitting position is 300 mm. water Art., in a lying position - 100-200 mm. water Art. pressure is assessed based on the number of drops per minute. If the pressure is elevated, this may indicate inflammatory processes in the central nervous system, the presence of tumors, and hydrocephalus.
The liquid is divided in two (5 ml in a test tube) and the cerebrospinal fluid is sent for further research:
- immunological;
- bacteriological;
- physico-chemical.
A healthy person has clear, colorless liquor. When a pink, yellow tint or dullness appears, we can talk about the presence of an infectious process.
Studying the concentration of proteins makes it possible to identify inflammatory process in organism. A protein level of more than 45 mg/dl is a deviation from the norm, indicating the presence of infection. Infection is also indicated by an increase in the concentration of mononuclear leukocytes (the norm is up to 5). The liquor is also examined for glucose concentration, detection of viruses, bacteria, fungi, and detection of atypical cells.
Complications and possible consequences
Spinal cord puncture is a procedure that may involve dangerous consequences. Therefore, it should only be carried out by a qualified specialist with extensive experience and in-depth knowledge.
Possible complications:
- leakage of fluid into nearby tissues, which can cause severe headaches;
- paralysis lower limbs, convulsions if the anesthetic gets on the spinal membrane;
- massive hemorrhage due to increased load on the brain;
- damage spinal nerves needles can cause back pain;
- if the rules of antiseptics are violated, infection may occur, an inflammatory process or abscess of the meninges may develop;
- infringement nerve center, and as a result - a violation respiratory function.
If you do not follow the rehabilitation rules after a lumbar puncture, this can also lead to serious complications.
Spinal cord puncture is an informative diagnostic method that can help identify many diseases. If all rules and contraindications are followed, the procedure is practically safe, but the risk of complications still exists. Experts advise resorting to spinal tap only in case of emergency and no more than once every six months.
Puncture - 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. This puncture 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.
Pleural puncture should only be performed experienced doctor surgeon or anesthesiologist, since during manipulation there is a risk of damage to the lungs or large vessels. To perform this type of puncture, patients first undergo an ultrasound scan. 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 pleural cavity, the rubber tube is periodically pinched with forceps.
The step-by-step technique of the procedure is as follows:
- 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.
- Fills a two-cc syringe with 0.5% novocaine.
- He pierces the skin and, gradually introducing the anesthetic, slowly inserts the needle until a sensation of “failure” is felt.
- After which, he pulls the piston and uses it to extract pathological contents - blood, exudate, purulent masses.
- 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. Pleural puncture in in this case condition is carried out 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 local anesthetic, for example, novocaine, then, using a special needle, aspirates 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 the help of 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 maxillary sinus- simple and effective, but quite painful method treatment, which serves only as an addition to antibiotic therapy for sinusitis.
Puncture - taking a tissue sample for analysis. It is carried out by puncturing an organ or tumor. In addition to diagnostic purposes this procedure can also be performed in medicinal purposes. And today we will talk in detail about what it is puncture, does it hurt? how it is carried out.
Why is the puncture performed?
For diagnostic purposes, a puncture is performed by injecting a contrast agent to take tissue for analysis and to monitor pressure in various vessels. If the procedure is carried out for treatment purposes, injections are introduced into the organ or cavity. medications. In addition, using a puncture, excess liquid or gas is removed, and the organ is washed.
What types of punctures are there?
This procedure is used for various purposes and is carried out over different organs. Therefore, puncture is divided into several types:
. Pleural puncture;Spinal cord puncture;
Sternal;
Liver biopsy;
Kidney biopsy;
Joint puncture;
Follicle puncture;
Breast puncture;
Thyroid puncture;
Umbilical cord puncture or cordocentesis;
Ovarian cyst puncture.
Diagnostic puncture
In most cases, this manipulation takes place under general or local anesthesia. In this case, the question puncture, does it hurt? we can say that the procedure is completely painless. In cases where the procedure is performed without anesthesia, it feels similar to a regular injection during vaccination. To carry out a puncture, a thin hollow needle is used, which is carefully inserted into the desired area, for example, into a cyst. Then it is sucked out using a syringe. internal fluid. When the sample is received, it is sent for further histological examination to the laboratory. Depending on the organ, the procedure and the needle used may vary slightly, but in any case the principle remains the same.
Usually the puncture does not take more than 15 minutes, although 1 minute is enough for the puncture itself. The patient can be in a sitting or lying position, depending on the purpose of the study. Do not move while collecting the sample. If the patient moves involuntarily, the needle may damage nearby tissue or blood vessels. This will lead to unpleasant consequences.
Therapeutic puncture
For therapeutic purposes, puncture is performed in the same way. To reduce pain, anesthesia is performed. The puncture site is treated with alcohol or iodine solution. The only difference is that medicinal solutions are pumped in or excess fluid is removed. If fluid is pumped out of the tumor formation, it is sent for further study to the laboratory. This is necessary in order to accurately determine the cause of the tumor and thereby prevent relapse. The procedure can be carried out repeatedly. If indicated, it is used for both adults and children. The duration of the puncture in this case is on average 20 minutes, it depends on the organ being manipulated.
After the procedure
In most cases, rehabilitation after puncture is not required, but if necessary, it can last from 2 hours to a day. During this time, the patient is in the clinic, under the supervision of medical workers. This is necessary to prevent possible complications. After the puncture, minor symptoms may appear pain, lethargy and nausea. These are the consequences of anesthesia and puncture. All these sensations pass on their own, but various medications, including painkillers, can also be prescribed. The patient does not experience serious pain either during or after the procedure. Therefore, puncture is considered a painless and safe procedure. In our center, the puncture is carried out quickly and efficiently. You will not feel any pain. Come to our center in Moscow, we will definitely help you!
Shoshina Vera Nikolaevna
Therapist, education: Northern medical University. Work experience 10 years.
Articles written
For many, brain puncture is subconsciously considered dangerous, but in fact it is not. If performed by an experienced doctor, it is absolutely safe. It is thanks to it that it is possible to detect ulcers in brain tissue, determine the contents of neoplasms and the state of other pathologies.
But there are also a number of dangers that can be encountered with this procedure. Let's figure it out.
The puncture is performed with a special needle, which, penetrating the brain tissue, can draw fluid from it. To make a puncture safe, you need to follow a number of rules:
- The area of the head where the puncture will be made must be thoroughly disinfected. First, it is treated with hydrogen peroxide, and then generously lubricated with iodine.
- For the procedure, you cannot use a regular needle, only a special puncture needle with a blunt end. It is produced quite wide and equipped with a mandrel.
- There should be 2 needles, one of which will be a spare if the first one is blocked by brain tissue.
- The puncture should be made to a depth of no more than 4 cm. This is the only way to ensure the safety of the fence and prevent the penetration of purulent secretions into.
- Before the procedure, the patient must have a bowel movement.
- The patient must be completely immobile, so he can be fixed with special devices.
Areas of application, indications, contraindications
Such a study is carried out in areas where there is suspicion of pus formation, most often these are:
- lower part of the frontal lobe;
- inferior part of the temporal lobe;
- tympanic space;
- near the mastoid process.
A puncture is taken to diagnose brain pathologies, such as:
- infectious lesion of the central nervous system;
- inflammatory process in the central nervous system;
- bacterial, viral, fungal diseases;
- infection of brain tissue with tuberculosis or syphilis;
- bleeding;
- multiple sclerosis;
- neoplasms of any type;
- neuralgic pathologies;
- swelling of brain tissue;
- problems with the vascular system.
Important! Before the procedure, the patient must indicate in a special questionnaire the list of medications that he is taking for this moment whether he is allergic to anesthetics or medications and whether he has problems with blood clotting.
The procedure is prohibited if:
- the patient is at any stage of pregnancy;
- he is in a state of traumatic shock;
- lost a lot of blood;
- there are intracranial hematomas;
- brain abscess diagnosed;
- abundant;
- diagnosed with hypertension;
- there are abundant infectious and purulent lesions on the back;
- there are lumbar bedsores;
- the brain is injured.
How to carry out the procedure
Why the procedure is being done has been determined, now you need to understand the methods for carrying it out. They are different and directly depend on the area where the liquid is taken.
Anterior horn of the lateral ventricle
The ventricular procedure for this area is performed as follows:
- The patient lies on his back when a tumor in the brain is to be identified. Usually the patient lies down on the healthy side to make it more convenient for the doctor to perform a puncture on the injured side.
- The head is slightly tilted towards the chest.
- The puncture site is thoroughly disinfected and coated with iodine twice.
- Draw a puncture line, which should be guided by the arrow-shaped seam, passing the Kocher point. It is covered with a layer of brilliant green solution.
- The head is covered with a sterile sheet.
- Any local anesthetic to which the patient is not allergic is used to numb the puncture area, most often it is Novocaine.
- Using a scalpel, an incision is made along the intended line.
- A cut is made on the trepanation window on the exposed skull.
- On solid meninges the neurosurgeon makes a cross-shaped incision. Wax is rubbed in or electrocoagulation is performed. For what? To stop bleeding, the latter method being the most effective.
- The cannula is inserted into the brain tissue to a depth of no more than 5-6 cm so that it runs parallel to the incision line. When puncturing the wall of the lateral ventricle, the doctor will feel a slight dip.
- Yellowish cerebrospinal fluid will begin to flow through the submerged cannula. Having penetrated the cavity of the ventricle, the doctor fixes the needle and, using a mandrel, regulates the volume and speed of the withdrawn fluid.
Often present in the ventricular cavity high pressure, and if it is not controlled, the liquid will come out in a stream. This will lead to the patient developing neuralgic problems.
The permissible volume of fluid intake is in the range of 3-5 ml. It is important to note that in parallel with the preparation of the room for the puncture, the operating room is also prepared, since there is high risk that air may enter the area being examined, or the puncture depth will be excessive, which may cause injury blood vessel. In these cases, the patient will be urgently operated on.
In cases of puncture, children use the methods of collecting cerebrospinal fluid according to Dogliotti and Geimanovich:
- In the first case, the puncture is carried out through the orbit.
- In the second - through bottom part temporal bone.
Both of these options have significant differences from traditional procedure- they can be repeated as many times as needed. For infants, this procedure is carried out through open fontanel by simply cutting the skin above it. In this case, there is a serious danger that the baby will develop a fistula.
Posterior horn of the brain
The technology for collecting cerebrospinal fluid from the area is carried out in the following order:
- The patient lies on his stomach. His head is tightly fixed so that the sagittal suture is strictly in the middle cavity.
- The preparatory process is identical to the above procedure.
- The incision of the skull tissue is carried out parallel to the sagittal suture, but so that it passes through the Dandy point, which should be strictly in its middle.
- Take a needle number 18, which is used strictly for this type of puncture.
- It is inserted at an angle, directing the needle tip into the outer top edge orbit to a depth of no more than 7 cm. If the procedure is performed on a child, the puncture depth should not exceed 3 cm.
inferior horn of the brain
The principle of the procedure is similar to the previous two:
- the patient should lie on his side, because surgical field there will be the side of the head and the auricle;
- the incision line will go 3.5 cm from the external auditory canal and 3 cm above it;
- part of the bone in this area will be removed;
- an incision will be made in the dura mater of the brain;
- insert a puncture needle 4 cm, directing it to the top of the auricle;
- cerebrospinal fluid will be collected.
Clinical picture after the procedure
Of course, the symptoms after puncture sampling are different for everyone, but they can be combined into a general clinical picture:
- Pain in the head area of varying intensity and duration.
- Prolonged nausea and vomiting.
- Convulsions and fainting.
- Malfunction of the cardiovascular system.
- Impaired respiratory function; in rare cases, the patient may need artificial ventilation lungs.
- Neuralgic problems.
Whether the patient will have the above symptoms directly depends on the experience of the neurosurgeon and his skills. The procedure must be carried out strictly according to medical instructions, which can guarantee the absence of complications after puncture.
It is important not only to correctly fix the patient, but also to accurately determine the puncture area. Treatment of the affected area is important both at the stage of preparation for the procedure and after it. Upon completion of the collection, be sure to apply a sterile bandage.
It is important that the patient does not feel any discomfort, much less pain, at the time of the puncture.
Due to the fact that the procedure is most often prescribed for diagnosing pathologies, it is like any other diagnostic event, should be painless. The patient will be conscious at all times, so he should immediately inform the doctor about any discomfort that has arisen. This will help avoid a number of complications. The doctor will change the technology or completely interrupt the procedure.
Puncture is an important procedure in medicine, and taking cerebrospinal fluid from the brain even more so. Before it takes place the patient will pass a number of studies that will help identify possible contraindications. There is no need to worry; brain puncture is performed only by experienced specialists who know their job.
Modern medicine has a huge range of different ways to identify diseases and identify the true causes that caused them.
Diagnostic methods
Among the most popular and informative types of diagnostics are the following:
Laboratory research;Ultrasonography;
X-ray examination;
Electrographic studies.
Here you should pay attention to a very special research method - diagnostic puncture. This method is relatively new. It gained its popularity due to its comprehensive information content and the fact that using a similar method one can obtain information about almost any organ, substance or tissue. human body. Let's get acquainted with this method together, find out all its advantages and features.
What is a puncture?
Medical term– puncture, translated from Latin language means a prick or puncture. This is a special medical procedure in which tissue is collected using thin special needles. When carrying out such manipulations, specialists receive the material necessary for comprehensive research. This may be a piece of tissue or organ, a certain amount of intercellular, intervertebral, lymphatic, secretory or blood fluid. Also, using this procedure, you can examine any pathological formation in the body. In such cases, the doctor receives invaluable material, the research results of which are used to prescribe only proper treatment. The most informative in this regard can be considered the sampling of cerebrospinal fluid, since this substance is in direct relationship with nervous system and the general blood flow of a person. IN special cases When the diagnosis is questioned by several doctors, it is the diagnostic puncture that brings unconditional clarity to the patient’s condition. To do this, a specialist makes a puncture over the organ or tissue that needs to be examined and takes a small number of samples.
How are different types of punctures performed?
Note that such an event is carried out in a temporary hospital. In other words, to carry out manipulations, it is enough to spend thirty minutes in a specially prepared room with a specialized manipulation table. There are quite a large number of types of punctures, and they are carried out in such a way that the specialist has maximum access to the organ, tissue or cavity being examined. During spinal punctures, the patient lies on his side in the fetal position, with his knees pulled up to his stomach as far as possible. In this position, the intervertebral spaces increase and access to the intervertebral trunk becomes easier.
At diagnostic puncture joints, the patient is in a sitting position, and the doctor punctures the interarticular bursa, trying to extract its contents. During sternal puncture after disinfection skin over the subject bone tissue, and numbing this area with any of the anesthetic drugs, the doctor inserts a needle into the tissue until it rests on the bone. Next, the doctor continues inserting the needle until he feels a decrease in resistance and a characteristic cracking sound of the bone marrow tissue is heard. This type of puncture is used to determine hematopoietic diseases. In case of lung diseases, it is very often used to identify the true causes of the disease. pleural puncture. At pulmonary diseases Fluid accumulates in the interpleural area.
Such an accumulation significantly burdens general state sick. The study allows us to determine the nature of the accumulated fluid and identify the presence of pathogenic and pathological cells in it. During the procedure, the patient is in a sitting position, with his back bent and his head tilted slightly forward. A needle connected to a tube and a pump is inserted into the interpleural space, which will slowly and carefully suck out the fluid. After taking the required amount of liquid, the tube is clamped and the needle is removed. After treating the puncture site with iodine, it is sealed with a band-aid.
In cases where you need to receive treatment or undergo a thorough diagnosis, the best decision will be if you take advantage of the experience and knowledge of specialists and unique equipment that successfully work in our new medical center. Our medication base and modern medical and surgical equipment allow us to quickly and with a guarantee get rid of many insidious and dangerous diseases. The main thing is that the prices for our high-quality services pleasantly surprise all patients.
