Spinal puncture

Spinous spinous process is a more common diagnostic technique for aspirating bone marrow fluid through a needle. Diagnostic tests for cytology, bacteriology and parasitology. Treating diseases: malaria leukemia Indication Spinal spine puncture is suitable for the diagnosis of various blood diseases (taboos such as hemophilia), sepsis, or some infectious diseases require bone marrow bacteria culture, some parasitic diseases require bone marrow smears to find protozoa, malignant tumors Suspected bone marrow metastasis. 1, blood system diseases, various causes of anemia, leukemia, thrombocytopenic purpura, neutropenia or deficiency, unexplained whole blood cell reduction, unexplained leukocytosis or reduction, peripheral blood unidentified or abnormal cells and myeloproliferative Diseases, etc. 2, neoplastic diseases and lipid-like metabolic disorders, multiple myeloma, malignant histiocytosis, lymphoma metastasis, Gaucher disease, Sea-Blue Histiocytosis and Niemann-Pick disease. 3, parasitic diseases and infectious diseases septicemia, malaria, black fever and so on. 4, other long-term unexplained fever, systemic lymph nodes, liver, splenomegaly, bone pain, differential diagnosis of leukemia-like reactions, hypersplenism, systemic lupus erythematosus, radiation hematological damage. Contraindications 1, coagulopathy, such as congenital or acquired hemophilia. 2, puncture local infection. Preoperative preparation Cleaning plate, bone marrow puncture bag (including: 1 bone marrow puncture needle, 1 ml 5 ml syringe, 2 m1 syringe, 2 gauze, 1 towel, 1 disinfectant rubber glove, iodine, alcohol cotton ball, 2% 2% x 2 (or lidocaine) of lucaine, 6-8 sheets of clean slides, 1 piece of slides, and a bacterial culture bottle (prepared as needed). Surgical procedure Anterior superior iliac spine (1) The patient is supine, with a wide margin of the anterior superior iliac spine as the puncture point, and the local anesthesia after the conventional disinfection, the local anesthesia should reach the periosteum. (2) The left thumb and index finger of the surgeon fixed the skin inside and outside the anterior superior iliac spine, and the right hand held the puncture needle (fixed button fixed at 1.5-2.0 cm), and penetrated the periosteum vertically and then entered the medullary cavity 1 cm. (3) When there is a feeling of falling into the bone marrow cavity, immediately take out the needle core, connect 20ml dry syringe, and take about 0.2ml of bone marrow for smear examination; if culture, it should take 2-3ml. (4) Insert the needle core after the operation, apply the sterile gauze locally, and fix it with tape. Posterior iliac spine puncture (1) The patient is lying on the side, and the posterior superior iliac spine is generally above the buttocks, on both sides of the humerus; or the intersection point of 6-8 cm below the upper edge of the humerus and 2-4 cm below the spine is the puncture point. (2) The direction of the puncture needle is slightly perpendicular to the back and slightly inclined to the outside. Sternal stem puncture (1) The patient is placed on the supine treatment table, and the shoulder and back cushions are used to tilt the head as far as possible and turn to the left side to fully expose the upper sternal notch. (2) The surgeon stands on the side of the patient's head. First use the left thumb to find the upper sternal notch, and close the upper edge of the sternum handle to press the skin down. The right hand needle is inserted from the center of the incision along the horizontal direction of the sternum stem. Slowly spin and puncture, reaching the middle of the upper edge of the sternum stem, about 1-1.5cm deep. Bone marrow puncture (1) The patient sits on the chair sideways or in the opposite direction, and the arms are placed on the back of the chair and on the headrest arm. (2) The lumbar spinous process of the above part is the puncture point, the left thumb and the index finger fix the skin above and below the spinous process of the predetermined puncture, and the right hand needle is inserted vertically from the side or the center of the spinous process. Tibial puncture (only for children under 2 years old) (1) The child is placed on the supine treatment table, and the lower limb is fixed by the assistant. The medial lateral humerus was selected as the puncture site approximately 1 cm below the plane of the tibial tuberosity (or 1/3 of the upper tibia). (2) The left thumb and the index finger fix the skin, and the right hand holds the needle, piercing it in the vertical direction in the middle of the bone surface.

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