Sampling by lumbar puncture

Lumbar puncture involves inserting a sterile needle into subarachnoid space , usually between the 3rd and 4th lumbar vertebrae . This procedure is performed to detect the presence of blood in the liquid cerebrorahidian to obtain samples for analysis thereof in order to inject contrast agent to perform various anesthesia , to introduce various drugs or to decrease intracranial pressure .
It requires sterile technique and a correct positioning of the patient. Lumbar puncture is performed by the physician assistant helped .

Materials needed:

  • Working table / trolley
  • sterile gloves ( for doctors and nurses )
  • disinfectant
  • sterile compresses
  • alcohol pads
  • means opening the sterile field
  • syringes
  • sterile
  • local anesthetic (usually lidocaine 1%)
  • spinal needles
  • manometer
  • adhesive bandage
  • sterile CSF collection tube (liquid cerebrorahidian )
  • Laboratory analysis request form
  • labels

 confirming patient identity
 patient explains the procedure to reduce anxiety and ensure cooperation to
 written consent of the patient
 inform the patient that may be headache after puncture , but if you cooperate and follow the instructions exactly , the effects are much reduced
 will avoid sedatives and analgesics before lumbar puncture , particularly in patients diagnosed with central nervous system disorders , as it may mask important simpome
 ensure patient privacy during surgery
 wash hands well
 table sits materials work taking care not to contaminate the sterile materials unfold
 ensures brightness and adjust the bed height to be patient to reach medical
 patient is positioned properly and is reminded to remain as motionless to minimize discomfort and possible trauma ( patient is lying on the bed in the lateral decubitus position , as close to the edge of the bed . Chin should be in the chest and knees up and place the abdomen. Such patients will be looped back to the bed . This position is best suited for lumbar puncture )
 to help the patient to maintain proper position we placed a hand behind his head and one behind the patient’s knee and gently pull inward . During insertion of the needle patient kept firmly in this position to avoid unwanted accidents
 doctor will disinfect the puncture site with sterile compresses , 3 times by 3 different packs . Then he sat at the opening sterile field venipuncture
 patient is warned that he will feel a burning sensation and local pain . I will be required to report any persistent pain as this may be due to irritation of nerve roots requiring needle repositioning
 after the doctor inserted the needle , it will be indicated procedures (injection of contrast agents, anesthetics, intracranial pressure by attaching gauge reading , collection of CSF in sterile tubes )
 after sampling and removing the needle puncture site with a disinfectant wipe and apply a dressing
 completed lab forms , properly labeled tubes and sent to the lab .

Special considerations :
 will carefully monitor the patient throughout the surgery and will immediately notify any change of values ​​or vital signs of the patient’s general condition
 patient will have to lie down in bed between 8-12 hours after puncture
 CSF samples collected should be sent immediately to the laboratory because they can not be refrigerated and sent later
 complications may be different from headache is the most common to the herniation of the cerebellar tonsils and spinal cord compression
 other side effects may be anesthetic , epidural or subdural abscess , bleeding into the spinal canal
 local pain , swelling or hematoma at the puncture , transient difficulty micţionare , fever
 although cerebellar tonsil herniation is very rare , the practice is that preventative brain CT scan before lumbar puncture . So if you highlight a cranial tomography intracranial expansive process , indicate delay lumbar puncture
 Lumbar puncture is also very useful in diagnosing meningitis


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