This manipulation has another name - lumbar, in most cases used in neurology for the establishment of a final diagnosis by taking a cerebrospinal fluid and analyzing it. The procedure has its own indications, contraindications and features.
Lumbar puncture - indications
If a patient is assigned a spinal puncture, the indications to this may be absolute and relative. That is, carrying out the manipulation is mandatory or you can do without it (in this case the attending physician decides). As for the diseases, the absolute indications are the following:
- infectious diseases of the central nervous system;
- malignant neoplasms;
- hemorrhage.
Relative indications are:
- multiple sclerosis;
- polyneuropathy ;
- septic embolism of vessels;
- fever of unknown origin in children under 2 years;
- systemic lupus erythematosus .
The indications for the procedure also include:
- spinal anesthesia before surgery;
- anesthesia of childbirth;
- measurement of pressure in cerebrospinal fluid (cerebrospinal fluid);
- introduction of medicines.
What is dangerous spinal puncture?
Puncture of cerebrospinal fluid is one of the most complex diagnostic manipulations that should be performed by a qualified specialist and necessarily in a hospital. The main danger is the infection in the spinal cord and its damage. Paradoxically, when the lumbar puncture is performed, the spinal cord itself remains unaffected.
Lumbar puncture - is it painful?
Lumbar puncture is performed with preliminary local anesthesia with lidocaine. Feelings after the introduction of this anesthetic experienced almost everyone: it is numbness, similar to the treatment of teeth. Due to anesthesia, the injection itself is practically painless. If the spinal nerve is injured, the patient may feel a chamber similar to a current shock. Complaints about a headache are common.
Here's how to alleviate the symptoms of spinal puncture:
- From the very beginning, after the manipulation, the patient is prescribed absolute bed rest for at least 18 hours. Sometimes, if necessary, it is extended to 3 days.
- Pain (head and puncture site) is prescribed analgesic therapy in the form of NSAIDs.
- Also, the patient is recommended a generous warm drink. If necessary, plasma substitutes are introduced.
Contraindications to lumbar puncture
This manipulation for specialists is not particularly difficult. But since there is a possibility of possible negative consequences, there are also contraindications. For diagnostic purposes take only 5 ml of CSF, and a day it is formed about 700 ml. When you inject a contrast agent into the needle, about 10 ml of fluid enters the spinal space. It is possible to get infections through the needle, as well as injured vessels. Proceeding from the above, the procedure should not be carried out:
- with intracranial hematoma, infringement of the brain stem, its edema, abscess, volumetric formation and other alterations of the brain;
- with traumatic shocks;
- with a large lesion of the dorsal tissues and pressure sores in the place where the puncture is made;
- with hemorrhagic diathesis;
- with pathologies of the spinal canal and impairment of the circulation of the cerebrospinal fluid;
- with the occlusal form of hydrocephalus.
One of the unpleasant and often occurring consequences is a headache after a spinal puncture. It is often found in patients of different ages. As a rule, when you get up, pain increases, while lying in a lying position, on the contrary, it decreases. Needles of smaller diameter reduce the incidence of headache. Often the symptom passes by itself and spontaneously. Also to get rid of it, bed rest, copious drink, analgesics and caffeine are used.
Set for spinal puncture
For manipulation, the following set of tools, preparations and materials is needed:
- iodine solution 5%;
- alcohol
- collodion;
- solution of novocaine 0.5%;
- syringes 5 and 10 ml;
- thin needles to syringes;
- needle for lumbar puncture (the most convenient flexible iridium-platinum needles that do not break and do not rust);
- a water pressure gauge to monitor the pressure of the cerebrospinal fluid;
- test tubes are sterile, napkins and cotton wool.
Preparing for spinal puncture
Spinal (lumbar) puncture involves preliminary training. To begin with, the doctor must find out the following:
- in relation to a female patient, whether she is pregnant;
- whether the patient has allergic reactions to drugs and anesthetics;
- Whether any medications are being taken at the moment;
- about violations of blood clotting.
Some kind of complex preparation does not require manipulation. There are only certain rules. The patient should be emptied of the bladder and the intestine is cleaned. The last meal is made no later than 2 hours before the procedure. It is recommended to abstain from smoking on the day of lumbar puncture. All other procedures and medications are canceled.
Spinal puncture
Lumbar puncture - technique of implementation:
- Treatment with antiseptic soap, then with alcohol or iodine.
- Apply a wipe around the puncture site.
- The patient takes the necessary position: lying on his side, bending his knees, pressing his head to the chest or sitting, bending his back forward.
- Treatment of the puncture site with alcohol.
- Determination of the puncture site (in adults between 2 and 3 lumbar vertebrae, in children between 4 and 5).
- The introduction of a local anesthetic (a solution of novocaine or lidocaine).
- After 2-3 minutes waiting for the action of the anesthetic, a needle is inserted for the spinal puncture. With the correct administration, the doctor and patient feel it is falling into the dura mater.
- Removal of mandrin, begins to flow liquor.
- Pressure measurement by manometer.
- Apply a sterile bandage to the puncture site.
Spinal puncture - consequences
In general, complications after manipulation occur infrequently, but even if the puncture of the cerebrospinal fluid is properly performed, the consequences are still possible. As mentioned above, this is a headache, and also:
- nausea;
- vomiting;
- dizziness.
When the technique of spinal puncture is broken:
- bleeding;
- paresis;
- meningic reactions;
- infectious diseases, etc.