Spinal tap

Lumbar puncture (synonym: lumbar puncture, a lumbar puncture) is the operation that is performed to retrieve the cerebrospinal fluid, or for insertion into the spinal canal drug or the contrast media. If the diagnostic lumbar puncture investigated fluid pressure, color, opacity, composition, produce biochemical and serological reactions or enter the air when pneumoencephalography.
For diagnostic purposes lumbar puncture produce mental and nervous diseases, particularly meningitis, trauma the brain and spinal cord, with vascular diseases and for special reasons with brain tumors.

lumbar puncture
With the medical purpose lumbar puncture produce to reduce the pressure of the cerebrospinal fluid with meningitis, open edema of the brain to release cerebrospinal fluid from the blood and decay products after operations on the brain, spinal cord, and also for introduction into the subarachnoid space of drugs.
A lumbar puncture is recommended in the supine position of the patient on the left side. Sick ducks his head to his chest, and legs, bent at the knee and hip joints, leading to the stomach. Back patient should be as bent arc. To give the bent position of the weak patients, nurse brings his hands under the back of the head and knees patient and draw them together, creating the position of the spine. The operating field in the lumbar-sacral area treated with alcohol and a weak solution of iodine.
After compulsory layered anesthesia (3-4 ml of 1% solution novokaina) soft tissues between the spinous processes of III and IV or the fourth and fifth lumbar vertebrae being thin needle with mandrel, held in the subarachnoid space. Upon removal of the mandrel of the lumen of the needle starts to separate the cerebrospinal fluid. After measuring the pressure of the cerebrospinal fluid collected in a sterile tube and urgently transported to the laboratory. For diagnostic purposes you can just output of 5-6 ml of liquid. Suspected tumor, abscess, cysticercosis brain, closed edema of the brain (see Hydrocephalus) need to be especially cautious and extract dropwise not more than 2-3 ml of fluid, partially removing the rod. The needle is removed along with the mandrel, the place of injection grease alcohol solution of iodine and stick with collodion. After a lumbar puncture patient lay on his stomach and nurses carry it with litter on the bed. The nurse must ensure that the patient within 2-3 hours lying in bed on his stomach, without a pillow, and later on his side. In order to avoid complications after spinal puncture, the patient is recommended strict bed rest is not less than 2-3 days.
Absolute contraindication to spinal puncture is purulent processes in the lumbar-sacral region.
After a lumbar puncture may headache, back pain, nausea, rarely vomiting and meningeal symptoms, which is appropriate to assign hexamethylenetetramine (methenamine), analgesics, preparations of Valerian. These phenomena are usually 3-4 days. In patients with brain tumors may experience more severe complications: tonic convulsions, unconsciousness, respiratory failure and cardiovascular activities, caused by the displacement of the brain and infringement of its trunk. You need to lift the foot of the bed 40-50 cm and immediately call a doctor on-call.

Lumbar puncture (punctio lumbalis; synonym: spinal tap, a lumbar puncture) is the operation that is performed to retrieve the cerebrospinal fluid, or for insertion into the spinal canal drug or the contrast media. Diagnostic lumbar puncture is performed for research pressure, color, transparency and structure of the cerebrospinal fluid, and also for introduction into Podporina space contrast agents in the production of myelography and pneumoencephalography. Therapeutically, a lumbar puncture is performed for the temporary reduction of cerebrospinal pressure, extraction of a significant amount of cerebrospinal fluid (up to 10-30 ml) meningitis and spinal fluid, containing a large amount of blood and degradation products after operations on the brain, and also for introduction into Podporina space of medicinal substances.
Contraindicated lumbar puncture when the danger of the emergence or strengthening tentorial grieving of herniation before surgery temporal lobe of the brain and mistreatment of the tonsils in great occipital hole. These phenomena can be observed subtentorial tumors and abscesses of the brain and with supratentorial placing them in situations when there are symptoms dislocation of the brain. Lumbar puncture in these patients is produced only at the absolute indications in the neurosurgical hospital, as is often the puncture arise urgent indications to surgery. At the risk of dislocation of the brain extract only a small amount of cerebrospinal fluid (2-3 ml)required for the study. With the aim of slow release liquids rod only partially removed from the lumen of the needle.


Technique lumbar puncture. Patient is placed on its side with sharply bent in Tazo-hip and knee joints, legs slightly bent his head, situated on the same horizontal plane with the body. After the treatment the skin on extensive period of gasoline, alcohol and iodine doctor probes spinous processes and outlines the puncture site. Typically, a lumbar puncture is performed in between the spinous processes LIII and LIV, which are located approximately on the horizontal line connecting ridges Ilium. At the puncture site strictly in the sagittal plane thin needle is injected intradermally and subcutaneous down to the bone 1-3 ml of 0.5% solution novokaina, fear of hitting the needle and the introduction of the solution in Podporina space. Then pull the needle and using a special needle thickness 0,5-1 mm, length 9-12 cm, the sharp end of which is cut at an angle of 45 degrees, produce puncture intrathecal space. Lumen needle closed well-adjacent and easily sliding mandrin, internal segment which corresponds exactly to the clearance of the inner end of the needle. Outside the rod equipped with rough hat that you can easily grasp the extraction and the introduction of the mandrel. Needle in a puncture send strictly in the sagittal plane and a few up so that she passed the skin and subcutaneous tissue, yellow cord, epidural fat cells, solid and arachnoid mater, got century intrathecal space. In the moment of penetration Dura the doctor there is a kind of feeling "of dropping needles". Then a needle pushed for another 1-2 mm and take the rod, and then follows the cerebrospinal fluid.
Thin beams, located in Podporina space can stick to the lumen of needles and hindered or stopped after spinal fluid. When turning the needle on 30 - 180 degrees light promoting its backward or forward this obstacle may disappear and the fluid begins to flow out of the needle faster.
If a needle starts to flow bloody spinal fluid, resulting from damage to the blood vessels at the time of production of the puncture, and not subarachnoid hemorrhage, in the absence of contraindications should continue to release the fluid. It is often soon begins to flow transparent spinal fluid, suitable for research.
For diagnostic purposes retrieves 2-3 ml of cerebrospinal fluid (for basic research of its composition). If necessary, other studies (Wasserman and so on) should be extracted 5-8 ml of liquid. For measuring the pressure of the cerebrospinal fluid is widely used gauge tube - bent at a right angle glass tube of diameter 1 mm with two knee - long vertical graduated and short horizontal, United hollow rubber band with metal cannula. The free end of the cannula is injected into the outer clearance puncture needle that implies spinal fluid, heading in the horizontal and vertical knee measuring tube. At high pressure fluid, more than the length of the vertical knee last lengthen using additional tube that connects rubber tube with a vertical knee.
Measurement of pressure spinal fluid, usually made with the patient lying. If the norm in the lumbar spine in the study lying pressure ranges 100-180 mm waters. century, when the study in a sitting position it at the expense of hydrostatic pressure increases up to 250-300 mm