Oibriú snáthaidí puncture lumbar agus réamhchúraimí

(1) Operation: ① Explain the purpose and precautions of puncture to the patient, eliminate tension and fear, obtain cooperation, and ask to urinate. ② Do the procaine skin test before the operation, prepare all the supplies, bring it to the patient's bed, and cover it with a screen ③ The patient lies on the side of the hard board, removes the pillow, aligns the back with the edge of the bed, and lays out rubber towels, therapeutic towels, head Bend to the chest, hold the knees with both hands, bend the knees to the abdomen, and arch the back as far as possible to widen the intervertebral space and facilitate the puncture. ④Assist the patient to fix the posture during puncture and avoid movement to prevent the needle from breaking, especially for children. ⑤ The puncture site generally takes 3 to 4 lumbar intervertebral spaces, and the vertebral spine line connecting the iliac vertebrae on both sides is the 3rd lumbar intervertebral space. ⑥ The puncture site is strictly disinfected. The operator wears sterile gloves, drapes a hole towel, and uses 2 percent procaine for local infiltration anesthesia. ⑦ The operator holds the lumbar puncture needle (with the needle core) and inserts the needle vertically along the lumbar intervertebral space. When the needle is advanced to a depth of 4 to 6 cm (2 to 3 cm for children), the resistance suddenly disappears, indicating that the needle has entered the meningeal cavity. Pull out the needle core, and the cerebrospinal fluid will flow out automatically. At this time, let the patient relax the whole body, breathe calmly, stretch the lower limbs and head slightly, connect the pressure tube, and the liquid level can be seen to rise slowly. After reaching a certain level, it can be seen that the liquid level fluctuates with breathing. , this reading is the cerebrospinal fluid pressure; if the pressure is significantly increased, the needle core cannot be completely pulled out, so that the cerebrospinal fluid drips slowly to prevent the formation of brain herniation. ⑧ During the puncture process, pay attention to observe the changes of the patient's consciousness, pupil, pulse, and breathing. If the condition changes, immediately report to the doctor to stop the operation and assist in rescue. ⑨ It is necessary to know whether the subarachnoid space is blocked or not, and a dynamic test (also known as a neck pressure test) can be performed. That is, after measuring the initial pressure, compress the patient's side jugular vein for 10 seconds to observe and judge. A. If the cerebrospinal fluid pressure rises to 1 times the original level immediately after the neck compression, and drops rapidly to the original level within 20 seconds after the compression is relieved, it indicates that the subarachnoid space is not blocked. B. If the cerebrospinal fluid pressure does not rise after pressing the neck, it indicates that the subarachnoid space is completely blocked. C. If the pressure of the cerebrospinal fluid rises slowly after the neck is pressed, and then drops slowly or not after the pressure is relieved, it indicates that the subarachnoid space is not completely blocked. ⑩ Take 3-5ml of cerebrospinal fluid and send it to a sterile test tube. For bacterial culture, the mouth of the sterile test tube should be sterilized by an alcohol flame to receive the cerebrospinal fluid, and then the mouth and cotton plug should be sterilized by an alcohol lamp flame and then covered with a cotton plug. If needed for intrathecal injection, inject the liquid slowly. ⑾ Insert the needle core after the operation, pull out the lumbar puncture needle, disinfect the needle hole with iodine, cover it with sterile gauze, and fix it with tape. Do not wet the puncture site for 1 week. ⑿ Clean up the sheets and supplies, record the volume, color, and nature of cerebrospinal fluid, and send the collected specimens for testing immediately. (2) Matters needing attention: ① After the puncture, make the patient lie down on the pillow for 4 to 6 hours, and those with high intracranial pressure lie down for 12 to 24 hours. ②Prevent low-pressure headache, which is mainly caused by the puncture needle being too thick or getting up too early or the leakage of cerebrospinal fluid from the puncture hole. The headache aggravates when the patient is standing, relieves after lying down, disappears after 1 to 3 days, and can reach 7 to 0 days in the elderly. Once it occurs, the patient should lie down, drink more saline, or intravenously drip 500-1000ml of normal saline, or add pituitary hormone to promote the secretion of cerebrospinal fluid. ③In patients with increased intracranial pressure, lumbar puncture should not be performed to avoid sudden changes in the dynamics of cerebrospinal fluid, unbalanced pressure between the cranial cavity and spinal cavity, resulting in the formation of brain herniation. ④ If there is purulent infection at the puncture site, puncture is prohibited to avoid subarachnoid infection. ⑤ For intrathecal injection of drugs, an equal amount of cerebrospinal fluid should be released, and the drug should be balanced with normal saline, and the injection should be very slow. ⑥ If symptoms of brain herniation appear during the puncture process (such as unequal pupil size, unconsciousness, abnormal breathing), the fluid should be stopped immediately, and air or normal saline (10-12ml) should be injected into the spinal canal for hydrostatic injection. 20 percent Mannitol 250ml. ⑦ For those who are restless and unable to cooperate, it can be performed under sedative or basic anesthesia, and a special person is required to assist

Má tá aon cheist agat, déan teagmháil linn. Is féidir lenár gcuideachta snáthaidí saincheaptha éagsúla, snáthaidí leighis, snáthaidí puncture, snáthaidí hypodermic, snáthaidí bithóipse, snáthaidí vacsaín, snáthaidí insteallta, snáthaidí steallaire, snáthaidí tréidliachta, snáthaid pointe peann luaidhe, snáthaidí piocadh suas ubhagán, snáthaidí dromlaigh, etc Más gá duit saincheaptha táirgí snáthaidí, déan teagmháil linn. Táimid ag tnúth le d'fhiosrúchán! Is cinnte go sásóidh cáilíocht na dtáirgí a mhonaraítear inár monarcha tú!

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