Spinal cord puncture (lumbar puncture) can easily be called almost the most complex and responsible diagnostic procedure. Despite the fact that the name mentions the spinal cord, it is not directly affected, but cerebrospinal fluid, called cerebrospinal fluid, is taken. The procedure is associated with a certain risk, therefore, it is carried out only if there is an urgent need, exclusively in a hospital and by a highly qualified specialist. Why is a spinal cord puncture taken? Most often, spinal cord puncture is used to identify infections (meningitis), to clarify the nature of the stroke, diagnose subarachnoid hemorrhage, multiple sclerosis, identify inflammation of the spinal cord and brain, and measure cerebrospinal fluid pressure. Among other things, a puncture is performed to administer medications or a contrast agent during an X-ray examination to determine the presence of herniated intervertebral discs. How is a spinal cord puncture taken? During the procedure, the patient is in a lying position on his side; he must press his knees to his stomach and his chin to his chest. Thanks to the adoption of such a position, it is possible to move apart the processes of the vertebrae in order to facilitate the penetration of the needle. The area in the puncture area is disinfected first with iodine and then with alcohol. Then local anesthesia is performed with an anesthetic (Novocaine). Complete anesthesia from the use of an anesthetic does not occur, so the patient must prepare himself in advance for unpleasant sensations in order to maintain complete immobility.

The puncture is made with a special sterile needle, the length of which reaches 6 centimeters. A puncture is made in the lumbar spine, usually between the fourth and third vertebrae, usually below the spinal cord. As a result of the insertion of a needle into the spinal canal, cerebrospinal fluid flows out of it. The test usually requires 10 ml of cerebrospinal fluid. During the collection of a spinal cord puncture, the rate of its flow is assessed. A healthy person has cerebrospinal fluid that is clear and colorless, the flow rate of which is about 1 drop per second. If the pressure is increased, the flow rate of the liquid increases, and it can even flow out in a trickle. What are the dangers of spinal cord puncture? The spinal tap procedure has been performed for more than 100 years, but patients are often wary of it. One of the common myths is the assertion that during the puncture the spinal cord may be damaged, therefore paralysis cannot be avoided. As mentioned above, a lumbar puncture is performed in the lumbar region, which is located below the spinal cord, so it cannot be touched. There is also a concern about the risk of infection, although the puncture is carried out, as a rule, under the most sterile conditions. The risk of infection in this case is 1:1000. Other possible complications that may occur as a result of spinal cord puncture include the risk of bleeding (epidural hematoma), the risk that intracranial pressure may increase in patients with tumors or other pathologies of the brain, or the spinal nerve may be injured. Although if a spinal tap is performed by a qualified doctor, the risk is minimal and cannot exceed the risk of performing a biopsy of internal organs. A lumbar or spinal puncture cannot be called a simple procedure; it is aimed at extracting cerebrospinal fluid or, conversely, at administering special drugs. Every person faced with the need to carry out such a procedure is concerned about the degree of pain during the puncture. In general, this indicator can be affected by a person’s pain disorder and the doctor’s skills. According to many, this kind of procedure cannot be called pleasant, but it does not cause serious pain. Moreover, before its implementation, soft tissue anesthesia is performed. Accordingly, a person, as a rule, simply feels the penetration of the needle. During the puncture sampling, the needle may touch the spinal nerve, therefore, there may be a sensation similar to a slight electric shock. But there is no need to worry about the possibility of harm. It is considered impossible to suffer damage from this procedure, because there is no contact with the spinal cord, because the extraction site is chosen where it is absent. Doctors recommend taking a horizontal position for several hours after the procedure, because some patients sometimes suffer from headaches, often not very pronounced, which cannot be relieved with painkillers. Lying down can significantly reduce headaches. Diagnosis of cerebrospinal fluid is prescribed if a person suffers from nervous and mental illnesses. There is a necessary procedure for the presence of meningitis, spinal cord injuries, vascular diseases and brain tumors. Also, sometimes medications are injected into the puncture area, the cerebrospinal fluid is freed from blood and, after operations, from decay products; with the help of a puncture, the pathology of the spinal cord, multiple sclerosis and Guillain-Barre syndrome is determined. Contrast agents are injected to detect hernias.

A puncture is a medical procedure that is performed to diagnose or treat diseases. The procedure consists of piercing a tissue, organ, vessel or pathological neoplasm with a trocar or needle in order to collect fluid for laboratory testing, which will help confirm or refute the diagnosis.

What is the puncture used for?

The puncture is performed on the mammary glands, cartilage, bone tissue, prostate gland, as well as soft tissue neoplasms, lymph nodes, joints, liver, etc. It is also widely used in purulent surgery. puncture that shows existing purulent inflammatory processes. There are many indications for punctures in this area, these include suspicions of the following pathological processes:

. Paraosseous phlegmon;

An abscess located inside bone tissue;

Post-injection infiltrate;

Purulent pleurisy;

Purulent paranephritis;

Paraproctitis;

Douglas abscess.

In addition, puncture is simply necessary to study the bacteriology of the purulent process. Without this type of research, some medical procedures cannot be performed. For example, introducing an X-ray contrast agent into the bone, as well as into the bed of a vessel or body cavity. In addition, puncture is performed to introduce not only liquid media, but also gas, which are necessary for contrasting an organ or cells.

To qualitatively determine the focus of a pathological process or to determine the topography of organs, sometimes it is simply necessary to carry out puncture. What does it show such a procedure? The fact is that thanks to the introduction of a contrast agent during puncture, it is possible to examine the components of the blood and its circulation. This makes it possible to establish the extent of the pathological process and understand the causes of its occurrence. Puncture is an indispensable medical procedure. It is used in all areas of medicine.

What are the therapeutic purposes of puncture?

It has been used to treat diseases for quite a long time and today has not lost its relevance. Puncture is used for medicinal purposes for:

. Administration of pharmacological agents, blood components, blood substitutes;

Local anesthesia;

Introduction of pharmacological agents directly into tissues, organs or neoplasms;

Removing exudate, pus or blood.

How is the puncture performed?

Hair is first removed from the puncture area. The procedure itself is performed in a sterile room on the operating table. Depending on what type of puncture is performed, the patient may be in a lying or sitting position. The skin is lubricated with an alcohol solution. The needle is degreased with ether and inserted directly into the lesion to the required depth. To prevent air from entering the inserted cavity or organ, a special rubber adapter is placed on the needle. This adapter will not allow liquid to flow freely onto the needle. Then a syringe is put on the needle and the required punctate is pumped out. In modern medical centers, the examination is carried out under ultrasound or CT control. After the material is collected, it is placed in a test tube, and the needle is removed with a sharp and quick movement. The puncture site must be treated with an alcohol or iodine solution and a sterile bandage applied.

What complications may arise?

Puncture is not a serious surgical operation, but it is still a fairly serious medical procedure. Therefore, as after any other intervention in our body, puncture can cause some complications. These include:

. injury to blood vessels,

Thrombosis,

Hematoma,

Lung tissue damage

Laparocentesis,

Suppuration,

Inflammation,

Thromboembolism.

A well-performed puncture will help to avoid such negative consequences. Our clinic employs only highly qualified doctors with extensive experience who will carry out the procedure without the risk of complications. The clinic is equipped with the latest medical equipment, which will help visualize the puncture process and eliminate medical errors.

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Blood tests, no matter how extensive they are, are not always able to provide a complete amount of information about the state of the bone marrow and its functioning, because mature cells are usually present in the bloodstream. A sternal puncture allows a specialist to trace the nature of hematopoiesis and the morphological characteristics of blood cells, through which a specialist obtains a bone marrow sample for examination.

Red bone marrow is the most important tissue of the body, ensuring the maturation of all blood cells without exception. It contains stem elements and cells of all stages of maturation, which, after full formation, enter the peripheral blood to ensure immunity, gas exchange, thrombus formation, etc.

In newborn children, red bone marrow fills all the bones, but as they grow, its volume decreases and by the age of five it begins to be replaced by fatty (yellow) bone marrow. In adults, hematopoietic tissue is concentrated in the sternum, pelvic bones, vertebral bodies, long tubular bones, and ribs, where it is available for aspiration for the purpose of diagnosing various pathological conditions.

The term "sternal" implies that the bone marrow will be taken from the sternum, although it can also be obtained from the ilium or calcaneus (in young children). Puncture of the sternum seems to be a fairly simple and safe diagnostic method, provided that all precautions and manipulation techniques are followed.

Indications and contraindications for sternal puncture

The reason for examining bone marrow aspirate obtained from the sternum is suspicion of hematological diseases, a planned bone marrow transplant, or some infectious processes, when other routine examinations do not provide sufficient information. Sternal puncture is performed when:

• Anemia - severe iron deficiency, megaloblastic, aplastic.
• Tumors of hematopoietic tissue - leukemia, paraproteinemic hemoblastosis.
• Myelodysplastic syndrome.
• Leukemoid reactions, when the peripheral blood picture does not exclude tumor growth.
• Storage diseases of hereditary nature, metabolic disorders (Gaucher disease, Niemann-Pick disease).
• Visceral leishmaniasis.
• Suspicion of the presence of metastases of other malignant neoplasms in the bones (prostate cancer, for example).
• Assessing the effectiveness of treatment and monitoring the condition of hematological patients.
• Research and procurement of the resulting stem cells for transplantation to a donor or the punctured patient himself after courses of chemotherapy or radiation.
• Intraosseous administration of drugs.

An established diagnosis of chronic leukemia in the acute stage, as well as iron deficiency anemia, diagnosed through routine examinations, serve as relative indications for bone marrow puncture, that is, in these cases, the procedure can be abandoned.

Contraindications for sternal puncture there are also:

1. Severe bleeding disorders.
2. Old age in cases where sternal puncture is not the only possible diagnostic method.
3. Acute inflammatory and infectious lesions at the site of the intended skin puncture.
4. Patient refusal to study.
5. Severe concomitant diseases in the stage of decompensation (the question of the advisability of a puncture is decided individually).

Preparation and technique for performing sternal puncture

Sternal puncture is not a complex procedure; it is safe, does not require anesthesia and is performed both in a hospital and on an outpatient basis. Preparation for sternal bone marrow aspiration is extremely simple:

• The patient undergoes a blood clotting test and a general analysis no more than 5 days before the planned procedure;
• Two hours before the puncture, the last meal and water is possible;
• Before the procedure, the bladder and intestines are emptied;
• All medications are canceled, except those that are vital;
• On the day of the puncture, no other procedures are prescribed.

Before the manipulation, the patient must inform the doctor about all the medications he is taking, especially for anticoagulants and other blood-thinning agents, which should be discontinued due to the greatly increasing risk of bleeding while taking them.

The specialist who will perform the sternal puncture will find out information about the presence of allergies to medications, since the administration of anesthetics will be required. The patient is told in detail about the essence of the puncture, its purpose and the meaning of the upcoming operation. The doctor warns about the possible pain of the puncture and subsequent precautions. It is mandatory to obtain the written consent of the person being examined (or the parents during a puncture of the child) to carry out the procedure.

The technique of performing sternal puncture includes several stages:

Special precautions should be taken when puncturing the sternum in children. Their bone is softer and more elastic, so careless actions can pierce it through. If possible, the child should be immobilized so that his movements do not disrupt the process of puncture of the sternum.

Features of sternum puncture in children:

• Sternal puncture is possible only from two years of age;
• Special needles of smaller diameter than for adults are used;
• General anesthesia is possible.

Elderly people, patients receiving long-term corticosteroid drugs may suffer from osteoporosis, so precautions for through puncture, which is possible due to a decrease in bone tissue density, also apply to them.

The sternum puncture procedure is rarely performed without anesthesia - if it is unavoidable, and the patient has absolute contraindications to the administration of anesthetics. In such a situation, the patient is warned about the painfulness of the manipulation; it is possible to use tranquilizers before the procedure and analgesics.

The bone marrow obtained through a puncture of the sternum is placed on a glass slide, then a cytological preparation is prepared, which is assessed by a cytologist. When diagnosing hematological pathology, the latter pays attention to the structure of blood cells, their number, degree of maturity, and the ratio of various elements in the total volume of punctate.

Bone marrow extracted from the sternum can also be subjected to cytochemical, immunological, and histological examination. Histological assessment of punctate provides more opportunities to assess the ratio of fatty and active bone marrow, the state of the vascular component and cellular elements of varying degrees of maturity.

The results of a sternal puncture can be obtained on the same day if a cytological examination of a bone marrow smear is expected. With histological analysis and other more technically complex studies, the diagnosis is extended for a period of 7-10 days.

The above method of sternal puncture was proposed in 1927 by Arinkin M.I. and is still practiced to this day. The Kassirsky needle has been successfully used by hematologists for decades. It is durable, wide, has a removable handle that is convenient for insertion, and is also equipped with a limiter that prevents the needle from moving too deeply.

Video: sternal puncture technique

Complications and features of the postoperative period

The bone marrow collection procedure lasts approximately 20 minutes. After it, the patient is observed for about an hour, general health, pulse and blood pressure are monitored. You can leave the hospital the same day, but it is highly undesirable to drive, as there is a risk of fainting.

The puncture site does not require any treatment at home, however, for the first three days it is recommended to exclude water procedures so as not to introduce an infection into the puncture hole. Sternal puncture does not imply any restrictions on diet and nutrition. If there is severe pain at the puncture site, the patient can take a painkiller.

Following the precise technique of sternal puncture, using a Kassirsky needle with a limiter, and treating the puncture site with antiseptics virtually eliminates the likelihood of complications. In rare cases, adverse consequences are possible in the form of:

1. Through puncture (in a child or patient with osteoporosis);
2. Bleeding from the puncture site;
3. Infection of the puncture site (extremely rare);
4. Fainting states in emotionally labile persons, hypotensive persons, with insufficiently thorough psychological preparation of the patient for manipulation;
5. Shock in case of severe pathology of the cardiovascular system in elderly people.

In general, the sternal puncture procedure is easily tolerated and is extremely rarely accompanied by complications. Feedback from patients is mostly positive, and well-being and attitude towards the manipulation largely depend on the quality of preparation and competent conversation between the doctor and the patient. Some people note severe pain at the time of puncture and removal of material from the sternum, and in the next 2-3 days, others feel only slight discomfort.

Interpretation of sternal puncture results

Analysis of bone marrow obtained through sternal puncture shows the number of cellular elements in it, their ratio and degree of maturity. The myelogram characterizes the qualitative and quantitative indicators of the white germ of hematopoiesis:

• Myelokaryocytes (the total number of blood cells containing nuclei) are 50-250x10 9 per liter of blood;
• Megakaryocytes (precursors of platelets) - 0.054-0.074x10 6 per liter;
• Reticulocytes (precursors of red blood cells) make up 20-30% and increase with blood loss and hemolytic anemia;
• Blast cells - 0.1-1.1%, myeloblasts - 0.2-1.7%, promyelocytes - 0.5-8.0% of all elements of the white sprout of the bone marrow, lymphocytes - 1.2-1.5 %, monocytes - 0.25-2.0%, plasma cells - no more than 1%.

A decrease in the number of myelokaryo- and megakaryocytes is possible due to errors in the puncture, when the bone marrow is diluted with liquid blood.

The specialist studying the bone marrow punctate reflects in the conclusion the type of hematopoiesis, cellularity, bone marrow indices, the presence and number of uncharacteristic cells (for example, Hodgkin's in lymphogranulomatosis). Each of the sprouts is analyzed separately.

Bone marrow indices

To assess the quantitative content of each type of bone marrow cells, their ratio in 500 cells is calculated. An important indicator is bone marrow neutrophil maturation index, which is calculated by dividing the total number of white lineage precursor cells by the total number of band and segmented neutrophils. Normally, the indicator is 0.6-0.8.

Along with the assessment of the white sprout, the characteristics of erythropoiesis are also important. Erythroid element maturation index calculated by the content of erythroblasts and normocytes and is 0.8-0.9. This indicator characterizes iron metabolism, the degree of saturation of red cells with hemoglobin, and increased erythropoiesis in anemia.

After calculating the number of granulocytes and the total number of red germ cells containing nuclei, their ratio is calculated, which is normally 3-4: 1 - leuko-erythroblastic ratio.

Bone marrow indices make it possible to objectify data on absolute numbers and percentages of specific cell populations. So, increase in leuko-erythroblastic index characteristic of hyperplasia of the white germ of hematopoiesis, which is observed in chronic lympho- and myeloblastic leukemia, infectious diseases, intoxications, and it can also indicate hypoplastic anemia with a general depletion of bone marrow tissue.

Decrease in leuko-erythroblastic index is indicative of hemolytic, posthemorrhagic and megaloblastic anemia (with normal bone marrow cellularity), and in the case of bone marrow depletion, it indicates agranulocytosis (decreased leukocyte count).

The normal value of this ratio can indicate either complete health, or aplasia and hypoplasia of bone marrow tissue, when a more or less uniform decrease in the number of cells of both white and red sprouts is observed, which is why it is so important not to conduct isolated assessments of only the myelogram in order to avoid diagnostic errors.

Neutrophil Maturation Index with sufficient cellularity of the punctate, it increases in case of tumors of the hematopoietic tissue (leukemia), drug poisoning, and its decrease is usually characterized by bone marrow dilution due to errors during puncture.

The described myelogram criteria make it possible to assess hematopoiesis as a whole, but the specialist’s conclusion should not be categorical. It is important to correlate the results of the study of sternal puncture with the characteristics of the clinical picture and the data of peripheral blood analysis.

Patients and their relatives should especially be cautioned against independently assessing the results that may come into their hands. Such amateur activities usually lead to erroneous conclusions that can only harm the patient. Analysis of bone marrow puncture indicators is a complex process that requires the utmost attention exclusively from a specialist in this field, who can accurately indicate whether there are changes and whether there is anything to worry about.

Designed for biopsy of all types of soft tissues (liver, kidneys, thyroid, pancreas, prostate, breast, etc.)

For puncture biopsy, three groups of needles are used: aspiration; modified suction; cutting. Aspiration needles have thin-walled cannulas with tips sharpened at different angles and are used to conduct targeted fine-needle biopsy with aspiration of material for cytological examination. Modified aspiration needles have a cannula with sharpened sharp edges and tips of various shapes, designed for taking both cytological and histological samples. There are three types of cutting needles: Menghini, with a sharply sharpened working end, Tru-Cut, which has a cannula with sharp edges and an internal stylet with a notch, and spring-cutting with a special “gun”. Designed to obtain a tissue sample for histological examination. The method of execution and diagnostic accuracy of the study depends on the type of needle used and can reach 93-95%, which is comparable to conventional histology.

Sources of information

• Diagnostic and therapeutic technology / ed. Mayata V.S. - Moscow, 1969.

• Nurse's Handbook of Nursing / ed. Kovanova V.V. - "Medicine", Moscow, 1974. - 464 p. - 255 thousand copies.

Notes

Wikimedia Foundation. 2010.

See what “Puncture” is in other dictionaries:

PUNCTION, and, female. (specialist.). Puncture (tissue, cavity, vessel) for therapeutic or diagnostic purposes. | adj. puncture, oh, oh. Ozhegov's explanatory dictionary. S.I. Ozhegov, N.Yu. Shvedova. 1949 1992 … Ozhegov's Explanatory Dictionary

PUNCTURE- (punctio), puncture of the cavity with a syringe containing diagnostic or therapeutic. purpose. P. is used for emptying various kinds of liquids and gases from tissues and cavities (emptying P.), determining their presence (test P.), for bacterial, chemical. And… … Great Medical Encyclopedia

- (from the Latin punctio prick), puncture of the wall of a body cavity (for example, pleural), joint, vessel, organ, normal or pathological tissue for therapeutic or diagnostic purposes... Modern encyclopedia

- (from Latin punctio prick) puncture of the wall of any body cavity (for example, pleural), joint, vessel, organ, normal or pathological tissue for therapeutic or diagnostic purposes... Big Encyclopedic Dictionary

PUNCTION, puncture, female. (lat. punctio injection) (med.). A puncture in the skin made by a syringe or other devices for removing or introducing liquids, air or some gases. Ushakov's explanatory dictionary. D.N. Ushakov... ... Ushakov's Explanatory Dictionary

Noun, number of synonyms: 4 venipuncture (2) culdocentesis (1) paracentesis (2) ... Dictionary of synonyms

Puncture- (from the Latin punctio prick), puncture of the wall of a body cavity (for example, pleural), joint, vessel, organ, normal or pathological tissue for therapeutic or diagnostic purposes. ... Illustrated Encyclopedic Dictionary

Content

The main goal of monitoring the condition of the mammary glands is timely diagnosis of cancer. Since breast cancer is most effectively treated at an early stage of development, doctors try to promptly determine the nature of any nodular neoplasm in the breast. Breast puncture is performed in cases where other diagnostic methods, for example, mammography or ultrasound, do not show the whole picture of the processes occurring in the breast tissue. Breast biopsy is considered the most accurate examination method, eliminating the possibility of a false diagnosis.

What is breast puncture

A biopsy is the most accurate existing method for diagnosing breast pathologies. Thanks to the puncture, the doctor finds out the nature of the tumor and chooses the most suitable treatment method for the woman. The procedure allows you to determine whether a tumor is malignant (cancerous) or benign (fibroadenoma) with almost one hundred percent accuracy. In addition to diagnostic, the study also performs a therapeutic function. This occurs if there is a cystic growth in the mammary gland that must be removed through invasive surgery.

Why is a puncture taken?

Doctors recommend getting tested if any lumps in the mammary gland, flaking of the breasts, discharge from the nipples, or ulcers in the chest area are detected. What does the puncture show? The main purpose of a biopsy is to confirm or refute the presence of breast cancer. Puncture of a breast tumor in women with the listed symptoms reveals benign formations in 80% of cases and atypical cancer cells only in 20% of cases.

Types of biopsy needles

To take a puncture, use an automatic or manual syringe with needles of different diameters. A wide selection of instruments makes it possible to collect cytological materials from the mammary gland, taking into account the characteristics of existing tumors. So, for example:

• take liquid with a thin needle;
• tissue cells are removed with a thick needle;
• A trephine biopsy is performed using an automatic needle with a spring mechanism;
• medical wire is ideal for surgical biopsy (when a breast tumor or cyst is removed).

Results

The material collected during the puncture is sent to the laboratory for decoding. The doctor evaluates the results of the biopsy and prescribes adequate treatment for the sick woman. It is almost impossible to make an incorrect diagnosis based on breast tissue analysis. However, if ultrasound control was not carried out during the puncture taking process, the analysis of the puncture is called into question. The doctor could take cells from healthy tissue by deviating from the site of the nodule. If there are doubts about the diagnosis, it is worth performing an operation to remove the tumor, after which the material will be sent for histology.

Consequences

After a breast biopsy, women may observe signs of breast inflammation: it becomes more voluminous, touching causes pain, swelling and redness of the skin are noticeable. There is no need to treat these symptoms; after 2-3 days they should go away on their own. If your breasts do not look better after a few days and their size does not return to normal, there is a reason to visit a doctor. A possible reason for this is infection from non-sterile equipment.

How is a needle biopsy of the breast done?

On what day is it better to do a breast puncture? Doctors allow a breast biopsy to be performed on any day of the cycle, but it is better to take the test between 7 and 14 days. The procedure does not require any special preparation: the woman just needs to refrain from taking blood thinning medications and alcohol 2-3 days before the puncture. After the procedure, you should place an ice pack in the bra cup to avoid swelling or bruising at the puncture site.

A breast biopsy is performed with the patient in the supine position. Under the control of an ultrasound device, a puncture needle is inserted into the chest. When it gets inside the nodule, the doctor collects tissue cells by pulling out the syringe rod. The samples taken are placed on glass, dried and pigmented for further microscopic examination. Based on the results, which will be ready after 1-2 days, the doctor prescribes therapy. In the presence of multiple small compactions, treatment is conservative.