spinal puncture
| Noun | 1. | spinal puncture - removal by centesis of fluid from the subarachnoid space of the lumbar region of the spinal cord for diagnostic or therapeutic purposes |
spinal puncture
spinal puncture,
surgical penetration of the spinal canal by a hollow needle introduced between two of the lumbar vertebrae. The arrangement permits injection of antibiotics or anesthetics (see anesthesiaanesthesia[Gr.,=insensibility], loss of sensation, especially that of pain, induced by drugs, especially as a means of facilitating safe surgical procedures. Early modern medical anesthesia dates to experiments with nitrous oxide (laughing gas) by Sir Humphry Davy of England
..... Click the link for more information. ) as well as dyes to facilitate X-ray studies. It also allows withdrawal of cerebrospinal fluid (CSF), the plasmalike liquid cushioning the brain and spinal cord, in which case the procedure is known as a spinal tap. Examination of the CSF is useful in diagnosing disease of the central nervous systemnervous system,
network of specialized tissue that controls actions and reactions of the body and its adjustment to the environment. Virtually all members of the animal kingdom have at least a rudimentary nervous system.
..... Click the link for more information. . The fluid is first tested for pressure; a high reading may signal inflammation or tumor. If pressure is normal, a small sample can be taken. It is then analyzed for antibodies, white blood cells, cellular debris, bacteria, and other organisms. Unusual concentrations may indicate disorders such as spinal meningitis, polio, or cancer. The concentrations of protein, sugar, and other chemical components are also determined. Excessive protein may be a sign of spinal tuberculosis.
spinal puncture
puncture
[pungk´chur]lum·bar punc·ture (LP),
puncture
(pungk'chur) [L. punctura, prick]puncture of the antrum
Patient care
The antrum is irrigated with the prescribed solution (often warm normal saline solution) according to protocol. The character and volume of the returned solution and the patient's response to treatment are carefully monitored and documented. Ice packs are applied as prescribed for edema and pain; these are replaced by warm compresses as healing progresses. Assessments are made for chills, fever, nausea, vomiting, facial or periorbital edema, visual disturbances, and personality changes, which may indicate the development of complications.
arterial puncture
cerebrospinal puncture
cisternal puncture
CAUTION!
This procedure may be lethal if not done by one skilled in this technique.diabetic puncture
Bernard puncture.exploratory puncture
heel puncture
CAUTION!
The puncture should be made in the lateral or medial area of the plantar surface of the heel, while avoiding the posterior curvature of the heel. The puncture should go no deeper than 2.4 mm. Previous puncture sites should not be used.
lumbar puncture
Abbreviation: LPCAUTION!
Postprocedure headache occurs in about half of all patients who undergo lumbar puncture. Rarely reported complications of the procedure include cerebral herniation, epidural infection, epidural bleeding, paraparesis, and subdural bleeding.Procedure
Informed consent for the procedure is obtained except in dire emergencies when clinical judgment prevails. Appropriate equipment is gathered: sterile gloves and mask for the operator, skin antiseptic (povidine-iodine solution), local anesthetic (1% lidocaine), and a lumbar puncture tray containing sterile gauze sponges, fenestrated drape and towel, needles and syringe for anesthesia, spinal needles, 4 collection tubes, 3-way stopcock and manometer; and a small adhesive bandage.
The procedure and expected sensations are explained, and the patient is asked to remain still when positioned and to breathe normally. The patient is typically placed on his or her left side at the right edge of the bed or examining table with knees drawn up to the abdomen and chin down to the chest, or in a sitting position with legs over one side of the table and buttocks at the other, bending head and chest toward the knees. Either of these positions exposes the back to the operator and provides spinal flexion, allowing easy access to the lumbar subarachnoid space. The assisting nurse holds the patient appropriately to secure this position (one arm around the neck, the other around the knees, or holding both shoulders bent forward). Draping provides warmth and privacy. Next, the patient's skin is prepared with antiseptic solution, and a sterile fenestrated barrier is placed over the proposed puncture site. Local anesthetic is injected, and then the spinal needle, with its stylet in place, is slowly advanced between the vertebra into and through the dura and arachnoid membranes. The stylet that fills the needle is removed, and initial measurements are made of the opening intracranial pressure (ICP) with a manometer. When the procedure is performed for diagnosis, about 8 to 10 ml of fluid are collected and sent promptly to the clinical laboratory for analysis of cell count, glucose, protein levels, cultures stains, and special studies. The closing pressure should then be read, the needle removed, and a small impervious adhesive dressing applied, sometimes with collodion to prevent CSF leakage. See: illustration
Complications
Pain at the puncture site, infection, bleeding, neurological injury, death, and post–spinal tap headaches are all potential complications. Of these, postural headache, caused by chronic leakage from the puncture site, is the complication most often brought to the attention of health care professionals. It may be treated with the injection of a small amount of the patient's own blood epidurally, to form a blood patch. See: cerebrospinal fluid
Patient care
The nurse assists the operator throughout the procedure by numbering and capping specimen tubes for laboratory examination and by applying jugular vein pressure as directed. Reassurance and direction are provided to the patient throughout the procedure, and the patient is assessed for adverse reactions (elevated pulse rate, pain radiating into the limbs, pallor, clammy skin, or respiratory distress).
After the procedure, the nurse assesses vital signs and neurological status, particularly observing for signs of paralysis, weakness, or loss of sensation in the lower extremities. If CSF pressure is elevated, the patient’s neurological status should be assessed every 15 min for 4 hr, if normal, every hour for 2 hr, then every 4 hr or as ordered. The puncture site should be checked hourly for 4 hr, then every 4 hr for 24 hr, assessing for redness, swelling, and drainage. To decrease the chance of headache, oral intake (for spinal fluid replacement and equalization of pressures) is encouraged, and the patient should remain in bed in a supine position or with the head elevated no more than 30° for 4 to 24 hr (per operator or institutional protocol). The patient should not lift his or her head but can move it (and himself or herself) from side to side. Noninvasive pain relief measures and prescribed analgesia are provided if headache occurs.
Quincke puncture
See: Quincke, Heinrichspinal puncture
Lumbar puncture.sternal puncture
tracheoesophageal puncture
Abbreviation: TEPventricular puncture
spinal puncture
- noun
Synonyms for spinal puncture
noun removal by centesis of fluid from the subarachnoid space of the lumbar region of the spinal cord for diagnostic or therapeutic purposes
Synonyms
- lumbar puncture
- spinal tap
Related Words
- centesis