Features of preparation for lumbar puncture of the spinal cord: why do they analyze the cerebrospinal fluid. Puncture, why a person needs it

Cerebrospinal fluid. Since puncture is in many ways a risky event, it is prescribed only in cases of urgent need.

During the puncture procedure, the spinal cord, contrary to the name, should not be affected.

There are situations when, without lumbar puncture can't get by. This is due to the identification infectious diseases in a patient, for example, meningitis, can be prescribed to patients who have had a stroke, also to confirm multiple sclerosis and inflammation of the brain and spinal cord. In addition to this, puncture and as medical procedure for administering drugs in the presence of a hernia.

In any case, before prescribing a puncture, the doctor will conduct a number of other tests to make sure it is necessary, since the procedure may be. In order to take cerebrospinal fluid for analysis, a puncture is made in the lumbar region with a special needle. The puncture site should be below the spinal cord. After the needle is inserted, liquid begins to flow out of the canal.

In addition to analyzing the liquid itself, conclusions are also drawn based on the flow rate. If the patient is healthy, it will be transparent, only one drop will appear per second.

After the procedure is completed, the patient needs to lie down on a hard and flat surface for about two hours. It is also not recommended to sit or stand for about a day.

Is spinal tap dangerous?

What is the danger of a lumbar puncture? If the procedure is carried out correctly, no serious consequences the patient will not experience it. The main concerns are damage to the spinal cord and infection. In addition, the consequences include the appearance of bleeding, as well as an increase in intracranial pressure.

It should be noted that in qualified clinics only professional doctors perform spinal cord punctures. There should be no fear. A similar procedure can be compared with a conventional biopsy of one of the internal organs. However, without it it is impossible to make a correct diagnosis of the patient in a timely manner. The modern one is sufficiently developed for the procedure to be the safest for the patient. In addition, pain relief is given. The doctor fully advises on what position the patient should be in.

If we talk about contraindications, then these include even slight suspicions of brain dislocation.

Puncture (puncture) is a procedure for collecting fluid from cavities and tissues to clarify the diagnosis. It is also used in the treatment of pathological processes that occur with the release of fluid (for example, purulent, serous).

How to do a puncture

In diagnostics, puncture is used to detect fluid, determine its nature, chemical and cellular composition. Similar manipulation for suspected cancer, abdominal dropsy, purulent, etc. Puncture red bone marrow carried out to diagnose leukemia (blood cancer). Veins are punctured to collect blood for tests, as well as for blood transfusions. A spinal puncture is performed to obtain cerebrospinal fluid to study its composition.

The puncture is contraindicated for people suffering from hemophilia, as well as for hydatid cysts abdominal cavity.

The puncture is surgical intervention, therefore, when performing it, you must comply with the requirements of asepsis and antiseptics. The patient's skin at the site of the future puncture must be lubricated with iodine. When performing the manipulation they do local anesthesia by injecting a 0.25% solution of novocaine. After this, a puncture is performed. The needle is inserted deep into the body perpendicular to the skin until there is a feeling of no resistance. When moving it, the doctor must be careful, as there is a risk of injury. important organs And large vessels. After the needle is inserted, pull out the syringe plunger. If there is no liquid, the needle is moved a little deeper. After this or that result, the syringe is pulled out, and the puncture site is covered with a colloid bandage.

Possible consequences of puncture

As a result of violations of the puncture rules, the patient may develop various complications. For example, due to a violation of asepsis, an infection may be introduced into the body cavity with the formation of phlegmon or an abscess. If the needle is pulled out too slowly, pus may leak into the canal, which can cause inflammation. During puncture of the pleura, injury to the intercostal vessels is possible; puncture of the lung sometimes leads to the appearance of blood in the sputum.

Air entering the pleural cavity can cause shortness of breath.

After a spinal cord puncture, the patient may experience dizziness, headaches, pain, nausea, vomiting, convulsions, and numbness in the lower extremities. These symptoms disappear after ten to twelve hours. IN in rare cases More severe complications may develop that have fatal outcome(bleeding, meningitis). With ascites, during a puncture, injury to the abdominal organs is possible with heavy bleeding. During puncture, damage to the peritoneum with subsequent infection of the wound is possible. Complications of vein puncture are hematoma, necrosis of the subcutaneous tissue.

When a doctor prescribes a puncture, the patient immediately thinks about the unpleasant procedure with a needle. Many people think that it is too painful and do not always agree.

In fact, puncture is considered today one of the most accessible and informative methods diagnostics It is used to make a fence the required material for analysis. In some cases it is used for medicinal purposes. What is this procedure and how is it carried out?

What is the essence of the procedure?

Puncture is a modern method of diagnosis and treatment. The method involves puncturing tissue and penetrating internal organs to collect fluid or other material.

It is done using a syringe and a thin needle, which is used to pierce the internal organ, penetrating into its cavity.

This method is prescribed in the following cases:

For the diagnosis and treatment of diseases that cause the formation of fluid inside the organ;
For the diagnosis of internal formations (wen and other formations).

In 65% of cases, puncture is used for diagnostic purposes. With its help, material is taken for analysis and the disease is determined based on its results.

IN medicinal purposes the method is used to remove pus, fat and other unnecessary substances from the organ cavity and introduce it into it medicines. Thus, piercing acts as an alternative to surgery, available for some specific cases. Taking material with its help helps determine the character internal process without surgical intervention.

Types of puncture

This diagnostic method is used in many areas of medicine. Depending on the location of the disease or formation, a method is prescribed. The most common are the following:

Pleural puncture (lungs);
Spinal tap;
Abdominal puncture (used when fluid forms in the cavity outside the organs);
Puncture for performing a biopsy of internal organs (most often the liver and kidneys);
Bone marrow puncture;
Joint puncture to collect accumulated fluid;
Follicular (internal and external purulent formations);
Gynecological puncture (to get rid of a cyst or if retrouterine bleeding is suspected).

This is an incomplete list of types of punctures that are used in medicine; in almost every area, if necessary, this diagnostic method is allowed.

Features of the treatment and diagnostic procedure

Diagnostic puncture is used quite often. Depending on the desired area the doctor selects a special needle. Usually this thin instruments of various lengths that easily pierce fabrics.

The exact location is determined by the doctor by palpation or after an ultrasound examination. A needle is inserted into the cavity and liquid is slowly drawn in, then the resulting material is sent for examination. The puncture is small, it heals quickly without causing much inconvenience.

With a therapeutic puncture, the procedure is not much different. The preparation and materials used are the same, only the time increases. It takes more time to administer the drug or pump out fluid.

How to do a puncture correctly?

The main question that interests many is whether it is painful to perform the manipulation; the image of a needle scares many. If it is injected into deep tissues, the patient becomes scared.

In fact, this procedure can be carried out in different ways:

No painkillers;
Using local anesthesia;
Under general anesthesia.

It all depends on the location, on the organ that requires a puncture. This manipulation is carried out under complete calm, no movements should be made. Therefore, in the most difficult situations For example, when examining bone marrow, general anesthesia is used.

In milder cases, doctors use local anesthesia. Both general and local anesthesia make the puncture a completely painless procedure.

In the simplest situations, for example, during a puncture, you can do without anesthesia. In this case, the patient feels the same sensations as with a regular injection. Strong pain symptoms do not arise.

To ensure that the procedure is as effective as possible and at the same time safe for the patient, there is special scheme its preparation and implementation:

The procedure is performed exclusively in a hospital setting under the supervision of specialists;
You need to choose the most comfortable position for both the doctor and the patient, it all depends on the location of the procedure;
You need to tune in to the duration of the procedure; a diagnostic puncture lasts 15 minutes, a therapeutic puncture lasts 20-30 minutes;
Before the puncture, the area is treated with an antiseptic;
During the puncture, do not move so that the needle does not touch nearby tissue and vessels;
After collecting the material, it is immediately sent for analysis; prolonged contact with air should be avoided;
After the procedure, the patient is recommended to lie down for 20-30 minutes.

Diagnostics are carried out only as prescribed by a doctor, if necessary.

Are there any contraindications for puncture?

It is difficult to name general contraindications; it all depends on the specific case. Largest number prohibitions in spinal, lumbar, pleural and bone marrow puncture. These areas of research have a complex structure, so it is not carried out for infectious diseases and neurological pathologies.

The doctor does before the appointment general examination, looks at the results of the blood test and only then can he prescribe the procedure

Possible consequences

There are usually no side effects after a puncture. But in case of violation of the rules of conduct, the following complications may occur:

If the antiseptic procedure is violated, infection may occur and, as a result, the formation of;
The needle with its contents must be removed quickly; if the process is slow, pus can penetrate into the internal tissues;
There is no need to move, accidental puncture of blood vessels can cause bleeding.

The most dangerous puncture is considered to be the spinal puncture. It is more difficult to prepare for it and after that there may be minor side effects in the form of dizziness, headache, nausea. Usually the effects go away within a day. If this does not happen, you need to urgently consult a doctor.

It is important to note that complications occur in only 5% of cases, so you should agree to this procedure if necessary. A timely diagnostic procedure can save lives.

All materials on the site were prepared by specialists in the field of surgery, anatomy and related disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Spinal tap is the most important diagnostic method for a number of neurological and infectious diseases, as well as one of the routes of administration of drugs and anesthesia. Usage modern methods studies such as CT and MRI have reduced the number of punctures performed, but specialists cannot yet completely abandon it.

Patients sometimes mistakenly call the procedure for collecting cerebrospinal fluid a spinal cord puncture, although the nerve tissue should in no case be damaged or get into the puncture needle. If this happens, then we are talking about a violation of technique and a gross mistake by the surgeon. That's why more correct procedure called puncture of the subarachnoid space of the spinal cord, or spinal puncture.

Liquor, or cerebrospinal fluid, circulates under the meninges and in the ventricular system, providing trophism to nervous tissue, support and protection of the brain and spinal cord. With pathology, its quantity can increase, provoking an increase in pressure in the skull; infections are accompanied by changes in cellular composition; in case of hemorrhages, blood is found in it.

Puncture in lumbar region can be of a purely diagnostic nature, when the doctor prescribes a puncture to confirm or diagnose correct diagnosis, and therapeutic, if medications are injected into the subarachnoid space. Increasingly, puncture is used to provide anesthesia for operations on the abdominal and pelvic organs.

Like any invasive intervention, spinal puncture has a clear list of indications and contraindications, without which it is impossible to ensure the patient’s safety during and after the procedure. Such an intervention is not prescribed just like that, but there is also no need to panic prematurely if the doctor considers it necessary.

When is it possible and why not to do a spinal tap?

Indications for spinal puncture are:

Possible infection of the brain and its membranes - syphilis, meningitis, encephalitis, tuberculosis, brucellosis, typhus and etc.;
Diagnosis of intracranial hemorrhages and neoplasms, when other methods (CT, MRI) do not provide the required amount of information;
Determination of liquor pressure;
Coma and other types of disorders of consciousness without signs of dislocation and herniation of stem structures;
The need to administer cytostatics, antibacterial agents directly under the membranes of the brain or spinal cord;
Administration of contrast during radiography;
Removal of excess cerebrospinal fluid and reduction of intracranial pressure in hydrocephalus;
Demyelinating, immunopathological processes in nervous tissue (multiple sclerosis, polyneuroradiculoneuritis), systemic lupus erythematosus;
Unexplained fever, when pathology of other internal organs is excluded;
Conducting spinal anesthesia.

Tumors, neuroinfections, hemorrhages, hydrocephalus may be considered absolute indications to a “spinal cord” puncture, while in case of multiple sclerosis, lupus, unexplained fever, it is not always necessary and can be abandoned.

At infectious lesion tissue of the brain and its membranes, spinal puncture is not only important diagnostic value to determine the type of pathogen. It makes it possible to determine the nature of subsequent treatment, the sensitivity of microbes to specific antibiotics, which is important in the process of fighting infection.

When intracranial pressure increases, spinal cord puncture is considered perhaps the only way to remove excess fluid and relieve the patient of many unpleasant symptoms and complications.

The introduction of antitumor drugs directly under the membranes of the brain significantly increases their concentration in the focus of neoplastic growth, which makes it possible not only to have a more active effect on tumor cells, but also to use a higher dosage of drugs.

Thus, cerebrospinal fluid is taken to determine its cellular composition, the presence of pathogens, blood admixtures, identify tumor cells and measure the pressure of the cerebrospinal fluid in its circulation, and the puncture itself is carried out when drugs or anesthetics are administered.

In case of a certain pathology, a puncture can cause significant harm and even cause the death of the patient, therefore, before prescribing it, possible obstacles and risks must be eliminated.

Contraindications to spinal tap include:

Signs or suspicion of dislocation of brain structures due to swelling, neoplasm, hemorrhage - a decrease in the pressure of the cerebrospinal fluid will accelerate the herniation of the brainstem sections and can cause the death of the patient directly during the procedure;
Hydrocephalus caused by mechanical obstacles to the movement of cerebrospinal fluid (adhesions after infections, operations, congenital defects);
Bleeding disorders;
Purulent and inflammatory processes of the skin at the puncture site;
Pregnancy (relative contraindication);
Aneurysm rupture with ongoing bleeding.

Preparing for a spinal tap

Features of the conduct and indications for spinal puncture determine the nature preoperative preparation. As before any invasive procedure, the patient will have to undergo blood and urine tests, undergo a blood coagulation study, CT scan, and MRI.

It is extremely important to tell your doctor about all medications you are taking. allergic reactions in past, concomitant pathology. All anticoagulants and angioplatelet agents are discontinued at least a week in advance due to the risk of bleeding, as well as anti-inflammatory drugs.

Women scheduled for puncture cerebrospinal fluid and, especially during X-ray contrast studies, must be sure of the absence of pregnancy in order to exclude Negative influence for the fruit

The patient either comes for the study himself if the puncture is planned in outpatient setting, or it is delivered to treatment room from the department where he is being treated. In the first case, you should think in advance about how and with whom you will have to get home, since weakness and dizziness are possible after the manipulation. Before the puncture, experts recommend not eating or drinking for at least 12 hours.

In children, the reason for a spinal puncture can be the same diseases as in adults, but most often these are infections or suspected malignant tumor. Required condition The presence of one of the parents is considered to be present during the operation, especially if the child is small, scared and confused. Mom or dad should try to calm the baby and tell him that the pain will be quite bearable, and the study is necessary for recovery.

Usually a spinal tap is not required general anesthesia, just enter local anesthetics so that the patient can tolerate it comfortably. In more rare cases (allergy to novocaine, for example), puncture without anesthesia is allowed, and the patient is warned about possible pain. If there is a risk of cerebral edema and dislocation during a spinal puncture, then it is advisable to administer furosemide half an hour before the procedure.

Spinal puncture technique

To perform a puncture of cerebrospinal fluid, the subject is placed on a hard table on right side, lower limbs raised to abdominal wall and wrapped in arms. It is possible to perform a puncture in sitting position, but at the same time, the back should also be bent as much as possible. In adults, punctures below the second level are allowed lumbar vertebra, in children due to the risk of damage to spinal tissue - no higher than third.

The spinal tap technique does not present any difficulties for a trained and experienced specialist, and its careful observance helps to avoid serious complications. Puncture of cerebrospinal fluid includes several successive stages:

The specified algorithm of actions is mandatory regardless of the indications and age of the patient. The risk depends on the accuracy of the doctor’s actions the most dangerous complications, and in the case spinal anesthesia- degree and duration of pain relief.

The volume of fluid obtained during puncture is up to 120 ml, but 2-3 ml is sufficient for diagnosis, used for further cytological and bacteriological analyzes. During the puncture, pain at the puncture site is possible, so especially sensitive patients are advised to undergo pain relief and the administration of sedatives.

During the entire procedure, it is important to maintain maximum stillness, so adults are held in the desired position by a doctor’s assistant, and the child is held by one of the parents, who also helps the baby calm down. In children, anesthesia is mandatory and helps ensure peace of mind for the patient, and gives the doctor the opportunity to act carefully and slowly.

Many patients are afraid of puncture, because they are sure that it hurts. In reality the puncture is quite tolerable, and the pain is felt at the moment the needle penetrates the skin. As soft fabrics“impregnated” with the anesthetic, the pain goes away, a feeling of numbness or bloating appears, and then all negative sensations disappear altogether.

If during the puncture the nerve root, then it is inevitable sharp pain, similar to that that accompanies radiculitis, however, these cases are attributed more to complications than to normal sensations during a puncture. In case of spinal puncture during increased quantity liquor and intracranial hypertension As excess fluid is removed, the patient will notice relief, a gradual disappearance of the feeling of pressure and pain in the head.

Postoperative period and possible complications

After taking the cerebrospinal fluid, the patient is not lifted, but is taken in a supine position to the ward, where he lies on his stomach for at least two hours without a pillow under his head. Babies up to one year old are placed on their backs with a pillow under their buttocks and legs. In some cases, the head end of the bed is lowered, which reduces the risk of dislocation brain structures.

For the first few hours, the patient is under careful medical supervision; specialists monitor his condition every quarter of an hour, since the flow of cerebrospinal fluid from the puncture hole can continue for up to 6 hours. When signs of edema and dislocation of the brain appear, urgent measures are taken.

After a spinal tap, strict bed rest. If the cerebrospinal fluid levels are normal, then after 2-3 days you can get up. In case of abnormal changes in the punctate, the patient remains on bed rest for up to two weeks.

A decrease in fluid volume and a slight decrease in intracranial pressure after a spinal puncture can provoke attacks of headache, which can last about a week. It can be relieved with analgesics, but in any case, if such a symptom occurs, you should talk to your doctor.

Collecting cerebrospinal fluid for research may be associated with certain risks, and if the puncture algorithm is violated, the indications and contraindications are not carefully assessed, severe general condition patient, the likelihood of complications increases. The most likely, although rare, complications of a spinal puncture are:

Displacement of the brain due to the outflow of a large volume of cerebrospinal fluid with dislocation and wedging of the brainstem and cerebellum into the occipital foramen of the skull;
Pain in the lower back, legs, sensory disturbances due to spinal cord root injury;
Post-puncture cholesteatoma, when epithelial cells enter the spinal cord canal (using low-quality instruments, lack of a mandrel in the needles);
Hemorrhage due to injury to the venous plexus, including subarachnoid;
Infection followed by inflammation of the soft membranes of the spinal cord or brain;
When entering the intrathecal space antibacterial drugs or radiopaque agents - symptoms of meningism with severe headache, nausea, vomiting.

Consequences after a properly performed spinal tap are rare. This procedure makes it possible to diagnose and effective treatment, and with hydrocephalus itself is one of the stages in the fight against pathology. Danger during puncture may be associated with a puncture, which can lead to infection, damage to blood vessels and bleeding, as well as dysfunction of the brain or spinal cord. Thus, spinal tap cannot be considered harmful or dangerous if the indications and risks are correctly assessed and the procedure algorithm is followed.

Evaluation of the result of spinal puncture

Result cytological analysis The cerebrospinal fluid is ready on the day of the study, and if bacteriological culture and assessment of the sensitivity of microbes to antibiotics is necessary, the wait for an answer can last up to a week. This time is necessary for microbial cells to begin to multiply in nutrient media and show their response to specific drugs.

Normal cerebrospinal fluid is colorless, transparent, and does not contain red blood cells. The permissible amount of protein in it is no more than 330 mg per liter, the sugar level is approximately half of that in the patient’s blood. It is possible to find leukocytes in the cerebrospinal fluid, but in adults the norm is considered to be up to 10 cells per µl, in children it is slightly higher depending on age. Density is 1.005-1.008, pH - 7.35-7.8.

An admixture of blood in the cerebrospinal fluid indicates hemorrhage under the membranes of the brain or injury to the vessel during the procedure. To distinguish between these two reasons, the liquid is taken into three containers: in case of hemorrhage, it is colored homogeneously red in all three samples, and in case of damage to the vessel, it becomes lighter from the 1st to the 3rd tube.

The density of cerebrospinal fluid also changes with pathology. So, in case inflammatory reaction it increases due to cellularity and the protein component, and with excess fluid (hydrocephalus) it decreases. Paralysis, brain damage from syphilis, and epilepsy are accompanied by an increase in pH, and with meningitis and encephalitis it falls.

The cerebrospinal fluid may darken with jaundice or metastases of melanoma, it turns yellow with an increase in the content of protein and bilirubin, after a previous hemorrhage under the membranes of the brain.

The biochemical composition of the cerebrospinal fluid also indicates pathology. Sugar levels decrease with meningitis and increase with strokes; lactic acid and its derivatives increase in the case of meningococcal lesions, abscesses of brain tissue, ischemic changes, and viral inflammation, on the contrary, leads to a decrease in lactate. Chlorides increase with neoplasms and abscess formation, and decrease with meningitis and syphilis.

According to reviews from patients who have undergone a spinal puncture, the procedure does not cause significant discomfort, especially if it is performed by a highly qualified specialist. Negative consequences are extremely rare, and patients experience the main concern at the stage of preparation for the procedure, while the puncture itself, carried out under local anesthesia, passes painlessly. One month after diagnostic puncture the patient can return to his usual lifestyle, unless the result of the study requires otherwise.

Video: spinal tap

Lumbar puncture... It is also a spinal puncture, spinal puncture, lumbar puncture... From the name it is clear that the fence biological fluid(CSF) with a special needle is carried out from the intervertebral space in close proximity to the spinal cord. Last one correct implementation activities are not affected. The collected liquor is examined for the content of certain proteins, elements, and foreign organisms. Let's take a detailed look at the indications and contraindications for lumbar puncture, the procedure, a number of complications, and what it may entail.

What kind of event is this?

So, spinal puncture is the collection of a small volume of specific cerebrospinal fluid. The latter washes not only the spinal cord, but also the brain. There are three main purposes of the procedure - analgesic, diagnostic and therapeutic.

Why do they take a puncture from the spine? The procedure is usually recommended for the following:

Laboratory research collected cerebrospinal fluid. Helps determine the nature of the pathological process.
Determination of pressure in the cerebrospinal fluid.
Carrying out a spinal This method allows you to carry out a number of operative (surgical) interventions without general anesthesia, which is more harmful to the body.
Use of medications, chemotherapy drugs, special solutions. In most cases, they are injected into the subarachnoid space to reduce spinal pressure.
Cisternography, myelography.

Why is a spinal puncture taken?

In most cases, such a study allows the doctor to confirm or refute the presence of pathology in the patient’s brain or spinal cord.

For what diseases is a spinal puncture taken? This is a suspicion the following diseases(or monitoring their therapy, assessing the patient’s recovery):

Infections that affect the central nervous system are encephalitis, meningitis, arachnoiditis, myelitis. Other diseases of the central nervous system fungal, viral, infectious nature.
Damage to the brain and spinal cord as a result of the development of syphilis and tuberculosis.
Subarachnoid bleeding.
Abscess of the central nervous system organs.
Stroke - ischemic, hemorrhagic.
Traumatic brain injuries.
Malignant and benign tumors, affecting the spinal cord, brain, and its membranes.
Demyelinating pathologies of the nervous system. A common example is multiple sclerosis.
Guienne-Barre syndrome.
Other diseases of a neurological nature.

Now it is clear to us what the purpose of spinal puncture is. Let's move on to the next topic.

Contraindication to the procedure

Spinal puncture is an event that has a number of contraindications:

Space-occupying formations on the posterior cranial fossa or temporal lobe cerebral areas of the brain. Even taking minimum quantity lumbar fluid in in this case is fraught with dislocation of brain structures, infringement of the brain stem in the space of the foramen magnum. For the patient, this all threatens instant death.
The procedure is prohibited if the patient has purulent lesions skin, soft tissues or the spine itself at the site of the intended puncture.
Relative contraindications- pronounced deformations spinal column. These include scoliosis, kyphoscoliosis, etc. The procedure will be fraught with the development of complications.
Puncture is prescribed with caution to patients with poor blood clotting, as well as to patients taking medications that affect blood rheology. These are anti-inflammatory non-steroidal drugs, antiplatelet agents, anticoagulants.

Diagnostic preparation of the patient for the event

Before performing a spinal puncture, the following examinations are necessary:

Submission of urine and blood for analysis - biochemical and general clinical. Additionally, the quality of blood clotting is determined here.
Inspection and palpation of the lumbar spine. This makes it possible to detect deformations that may cause complications after the procedure.

Before the procedure

Before a spinal bone marrow puncture, you should not eat for 12 hours and drink for 4 hours. This is all the preparation that is required of the patient.

Immediately before the event, he must also do the following:

Start of the event

A lumbar puncture can be performed either in a hospital or in a clinic. The procedure starts like this:

The patient's back is washed with antiseptic soap and disinfected alcohol solution or an iodine preparation, after which they are covered with a special napkin.
The person is placed on the couch - he must be positioned horizontally on his right or left side.
The subject needs to press his head to his chest, and bend his legs at the knees and pull them close to his stomach. He is no longer required to participate.
When performing a spinal puncture on a child, it is important to explain to the little patient that during the procedure you need to remain calm and try not to move.
Next, the doctor determines the puncture site. It is done either between the third and fourth, or between the fourth and fifth spinous vertebral processes. The guideline for the required interspinous space will be the curve outlining the vertices ilium spine.
The selected puncture site is further processed effective antiseptic.
Next, for local anesthesia, the doctor gives the patient an injection of novocaine.

Performing a lumbar puncture

Let's look at how a spinal puncture is done:

After novocaine begins its action, the doctor punctures the selected location with a special needle. Its length is 10-12 cm, thickness - 0.5-1 mm. It is inserted strictly in the sagittal plane, heading slightly upward.
On the way to the intrathecal space, resistance from contact with the luteal and interspinous folds may be observed. The instrument passes through the fatty epidural tissue with relative ease. The next resistance comes from the strong meninges.
The needle advances gradually - 1-2 mm.
Next, the doctor removes the mandrin from it. After it, the liquor should flow out. Normally it is transparent and comes in scanty drops.
Using modern pressure gauges, the doctor measures the pressure in the cerebrospinal fluid.
It is strictly prohibited to draw out liquid with a syringe! This can lead to infringement of the brain stem and its dislocation.

Completing the procedure

After the fluid pressure has been measured, the required volume of cerebrospinal fluid for research has been taken, and the needle is carefully removed. The puncture area must be covered with a sterile bandage.

In order not to provoke Negative consequences spinal puncture, the patient must follow the following recommendations:

Maintain bed rest for 18 hours after the event.
On the day of the procedure, avoid active and strenuous activities.
You should return to normal life activities (without a gentle regime) only after permission from the treating doctor.
Taking painkillers. They reduce the severity of discomfort at the puncture site and fight headaches.

Patient's feeling

The whole procedure takes about 45 minutes. Spending all this time in the fetal position, in an almost motionless position, is considered uncomfortable for many subjects.

Reviews of spinal puncture also indicate that it is somewhat painful procedure. Unpleasant sensations are noted at the moment the needle is inserted.

Study: pressure measurement

This is the very first study that is carried out directly during the collection of cerebrospinal fluid.

The assessment of the indicators is as follows:

Normal pressure in a sitting position - 300 mm of water column.
Normal pressure in a lying position is 100-200 mm water column.

However, in this case, the pressure is assessed indirectly - by the number of drops flowing out in 1 minute. The normal value of cerebrospinal fluid pressure in the spinal canal in this case is 60 drops/min.

An increase in this indicator indicates the following:

Hydrocephalus.
Water stagnation.
Various tumor formations.
Inflammation affecting the central nervous system.

Laboratory research

Next, the cerebrospinal fluid is collected by the doctor into two 5 ml tubes. The liquid is sent to the laboratory for testing. necessary research- bacterioscopic, physicochemical, bacteriological, PCF-diagnostic, immunological, etc.

Among other things, when analyzing biomaterial, the laboratory technician is obliged to identify the following:

Protein concentration in the cerebrospinal fluid sample.
Concentration of white blood cells in the mass.
The presence and absence of certain microorganisms.
The presence of abnormal, deformed, cancer cells in the sample.
Other indicators characteristic of cerebrospinal fluid.

Normal indicators and deviations from them

Of course, it is impossible for a non-specialist to correctly analyze a sample of cerebrospinal fluid. Therefore, we present general introductory information about his research:

Color. Normally, the liquid is transparent and colorless. A pinkish, yellowish tint or dullness indicate the development of an infection.
Protein - general and specific. Increased performance(more than 45 mg/dl) indicate feeling unwell patient, infections, destructive and inflammatory processes.
White blood cells. The norm is no more than 5 mononuclear leukocytes. If there are more of them in the analysis results, then this fact may also indicate the development of an infection.
Glucose concentration. Low performance sugar in the biosample also indicate pathological processes.
The detection of certain bacteria, fungi, viruses, and other organisms in the cerebrospinal fluid indicates a corresponding infection.
Immature, deformed, cancer cells in the sample indicate the development of cancer.

Complications after the procedure

The consequences of spinal puncture may be as follows:

Infection. Occurs when medical staff violate antiseptic discipline. May manifest as inflammation meninges, development of abscesses. In this case, emergency antibacterial therapy to prevent death.
Dislocation complication. The consequence of a drop in liquor pressure is possible when volumetric formations in the posterior cranial fossa. Therefore, before the puncture, it is additionally necessary to conduct a REG and EEG.
Hemorrhagic complications. Consequence of damage to large blood vessels if the procedure is carried out carelessly. Hematomas and bleeding may occur. Requires urgent medical intervention.
Traumatic complications. Incorrect puncture may result in damage intervertebral discs, spinal nerve roots. For the patient, this is reflected in back pain.
Headache. Since when a sample is taken, the cerebrospinal fluid drops intracranial pressure, this is reflected in the patient by an aching, squeezing headache. The symptom goes away on its own after rest and sleep. However, if headache does not subside within a week - this is a reason to urgently consult a doctor.

Now you know how a lumbar puncture is performed. We also examined contraindications, indications for it, and complications that the procedure poses.

Spinal cord puncture (lumbar puncture) can safely be called almost the most complex and responsible diagnostic procedure. Despite the fact that the name mentions the spinal cord, it is not directly affected, but cerebrospinal fluid, called cerebrospinal fluid, is taken. The procedure is associated with a certain risk, therefore, it is carried out only if there is an urgent need, exclusively in a hospital and by a highly qualified specialist. Why is a spinal cord puncture taken? Most often, spinal cord puncture is used to identify infections (meningitis), to clarify the nature of the stroke, diagnose subarachnoid hemorrhage, multiple sclerosis, identify inflammation of the spinal cord and brain, and measure cerebrospinal fluid pressure. Among other things, the puncture is carried out for the purpose of administering medications or contrast agent during an x-ray examination to determine the presence of herniated intervertebral discs. How is a spinal cord puncture taken? During the procedure, the patient is cared for supine position on his side, he should press his knees to his stomach and his chin to his chest. Thanks to the adoption of such a position, it is possible to move apart the processes of the vertebrae in order to facilitate the penetration of the needle. The area in the puncture area is disinfected first with iodine and then with alcohol. Then local anesthesia is performed with an anesthetic (Novocaine). Complete anesthesia does not occur from the use of an anesthetic, so the patient must prepare himself in advance for discomfort in order to maintain complete immobility.

The puncture is made with a special sterile needle, the length of which reaches 6 centimeters. A puncture is made in the lumbar spine, usually between the fourth and third vertebrae, usually below the spinal cord. As a result of the insertion of a needle into the spinal canal, cerebrospinal fluid flows out of it. The test usually requires 10 ml of cerebrospinal fluid. During the collection of a spinal cord puncture, the rate of its flow is assessed. Healthy man has cerebrospinal fluid that is transparent and colorless, the flow rate of which is about 1 drop per second. If the pressure is increased, the flow rate of the liquid increases, and it can even flow out in a trickle. What are the dangers of spinal cord puncture? The spinal tap procedure has been performed for more than 100 years, but patients are often wary of it. One of the common myths is the assertion that during the puncture the spinal cord may be damaged, therefore paralysis cannot be avoided. As mentioned above, a lumbar puncture is performed in the area lumbar region, which is located below the spinal cord, so they cannot touch it. There is also a concern about the risk of infection, although the puncture is carried out, as a rule, under the most sterile conditions. The risk of infection in this case is 1:1000. Other possible complications that may occur as a result of spinal cord puncture include the risk of bleeding (epidural hematoma), the risk that intracranial pressure may increase in patients with tumors or other pathologies of the brain, or the spinal nerve may be injured. Although if a spinal tap is performed by a qualified doctor, the risk is minimal and cannot exceed the risk of performing a biopsy of internal organs. A lumbar or spinal puncture cannot be called a simple procedure; it is aimed at extracting cerebrospinal fluid or, conversely, at administering special drugs. Every person faced with the need to carry out such a procedure is concerned about the degree of pain during the puncture. Overall on this indicator may be affected by a person's pain disorder and the doctor's skills. According to many, a procedure of this kind cannot be called pleasant, but it does not cause serious painful sensations. Moreover, before its implementation, soft tissue anesthesia is performed. Accordingly, a person, as a rule, simply feels the penetration of the needle. During the puncture sampling, the needle may touch the spinal nerve, therefore, there may be a sensation similar to a slight electric shock. But there is no need to worry about the possibility of harm. It is considered impossible to suffer damage from this procedure, because there is no contact with the spinal cord, because the extraction site is chosen where it is absent. Doctors recommend taking horizontal position after the procedure for several hours, because some patients sometimes suffer from headaches, often of a not very pronounced nature, which cannot be relieved with painkillers. Lying down can significantly reduce headaches. Diagnosis of cerebrospinal fluid is prescribed if a person suffers from nervous and mental illness. There is a necessary procedure for the presence of meningitis, spinal cord injuries, vascular diseases and brain tumors. Also sometimes introduced medications into the puncture area, the cerebrospinal fluid is freed from blood and, after operations, from decay products; using puncture, the pathology of the spinal cord, multiple sclerosis and Guillain-Barré syndrome is determined. Contrast agents are injected to detect hernias.