How should a lumbar puncture needle be taken?

1. The patient lies on the side of the hard board bed, the back is perpendicular to the bed surface, the head is flexed forward and the chest is flexed, and the two hands are hugging the knees close to the abdomen, so that the trunk is arched. Or the assistant should stand opposite the surgeon, hold the head of the patient with one hand, and hold the fossa of both lower limbs with the other hand and hold it tightly, so that the spine can protrude as much as possible, so as to increase the width of the intervertebral space and facilitate needle insertion.

2. The puncture point is the intersection of the line connecting the posterior superior iliac spine and the posterior midline, usually the 3rd to 4th lumbar spinous process space, or the previous or next intervertebral space.

3. Routinely disinfect the skin, wear sterile gloves, lay a sterile hole towel, and use 2 percent lidocaine for local infiltration anesthesia from the skin to the intervertebral ligament.

4. The surgeon fixes the skin at the puncture site with the thumb and index finger of the left hand, and holds the puncture needle with the right hand to slowly pierce in the vertical back direction. When the needle passes through the ligament and dura, the resistance suddenly disappears (the depth of needle insertion in adults is 4 6cm, children are 2 4cm), then slowly pull out the needle core, you can see the outflow of colorless and transparent cerebrospinal fluid.

5. When you see that the cerebrospinal fluid is about to flow out, connect the pressure measuring tube to measure the pressure, read accurately, and count the number of cerebrospinal fluid droplets to estimate the pressure (normally 70-180mmH).

2 O or 40-50 drops.min). If the pressure is not high, ask the assistant to compress one side of the jugular vein for about 10 seconds, then press the other side, and finally press both sides of the jugular vein at the same time. If the pressure drops to the original level, it means the subarachnoid space is unobstructed. If the pressure does not increase after compression of the vein, it means that the subarachnoid space is completely blocked.

6. Remove the manometer tube, collect 2-5ml of cerebrospinal fluid, and send for routine, biochemical and bacterial culture tests.

7. For the treatment of meningeal leukemia, usually dilute 10 mg of methotrexate (MTX) with 4 ml of normal saline, add 5 mg of dexamethasone, and inject slowly into the spinal canal. .

8. After the operation, insert the needle core and pull out the puncture needle together, cover it with sterile gauze, and fix it with tape.

9. Postoperatively, lying on the back for 4-6 hours can avoid postoperative hypotensive headache.

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