Puncture, in medical terms refers to puncture of a body cavity, joint, organ or a pathological structure for diagnostic or therapeutic purposes.
Puncture division[edit | edit source]
- According to purpose:
- Diagnostic – sampling the body fluid (transudate, exsudate – most often pus, blood) or tissue sample for histological, cytological, microbial (culture) or biochemical examination.
- According to design:
- stepped (specific absces, joint) – protection against infections.
- According to the knowledge of the punctured unit:
Puncture units[edit | edit source]
- Natural cavities (pleural, pericardial, peritoneal, joints, bladder, paranasal sinuses, etc.).
- Parenchymatous organs (liver, kidneys, spleen, etc.) and bone marrow (aspiration biopsy or trepanobiopsy).
- Pathological formations (cyst, absces, tumor, hematoma, etc.).
Administration of the puncture[edit | edit source]
- Superficial formations may be punctured blindly;
- deep-seated formations and organs, punctures are performed under the control of ultrasound or CT;
- it is necessary to follow rules of asepsis and use appropriate local anesthetics.
- Puncture needles:
- vary in diameter and length;
- some contain mandrel, so they do not clog (very wide mandrel needles are called trocars);
- recently used Chiba-needle 15 to 20 cm in length, from 0,5 mm in internal diameter, that is soft and flexible and minimizes the risk of injury to surrounding structures.
Complications[edit | edit source]
- Complications of abdominal punctures include:
Punctures of body cavities[edit | edit source]
Puncture of the pleural cavity[edit | edit source]
- Based on the indication (gas, liquid) two approaches are used:
- according to Monaldi – puncture of pneumothorax – in the 2nd or 3rd intercostal space in medioclavicular line, in half-sitting position;
- according to Bullau – puncure of fluidothorax – in the 6th intercostal space along the anterior axillary line, in sitting position.
- The puncture can be followed by drainage, possibly performed:
- by using trocar (modification by Seldinger technique included: needle – guidewire – dilators – drain);
- blunt dissection by a peanut sponge.
Puncture of a pericardial cavity[edit | edit source]
- Through Larrey's left slit - trigonum sternocostale.
- If the intracardial drug administration is necessary (resuscitation), we puncture the left ventricle obliquely in the 5th intercostal space in the medioclavicular line.
Pucture of peritoneal cavity[edit | edit source]
- It is indicated primarily for ascites as a relieving procedure and for puncture examination ;
- it is performed outside the center of the left umbilicospinal line at the Monro point ;
- in women, the Douglas space is punctured through the posterior vaginal arch , transrectal access is possible with an abscess in the Douglas space ;
- diagnostic peritoneal lavage (ultrasound of the abdomen is prefered nowadays) in traumas is performed by punctures in all 4 abdominal quadrants.
- Aspiration biopsy – sternal puncture, puncture of the hipbone wing or tibia.
- Trepanobiopsy – wing of the hipbone;
- Bone marrow sampling sites are laid superficially, under the skin, hematopoiesis takes place here until old age.
Sternal puncture[edit | edit source]
- Performed at body of the sternum at the level of 2nd or 3rd intercostal space in the midline (in children, manubrium or tibia is preffered);
- Hynk needle is used;
- after disinfecting the skin and under local anesthesia (mesocain) the bone marrow is punctured and about 0,5–1 ml is aspirated into a syringe;
- it is stated, that the puncture itself with appropriate anesthesia isn't painful, throughout the aspiration the patient might feel unpleasant pressure (the sound made by a needle when penetrating the bone is unpleasant as well).
Trepanobiopsy[edit | edit source]
- A sample of both spongy bone and bone marrow is obtained in the form of a cylinder 15-20 mm high (in addition to marrow, the bone composition is also being determined);
- Performed out by Jamshidi needle.
Spinal tap[edit | edit source]
- Puncture is performed in the subarachnoid space (between arachnoid and pia mater spinalis).
- Main indications :
- Performed under L2 vertebra where the spinal cord ends and continues further down as spinal roots - so called cauda equina:
- between L3 – L4 vertebrae or L4 – L5;
- the patient is leaning forward (seated or lying on one side), so that the vertebral arches are as far apart as possible;
- the needle then penetrates the skin and subcutaneous tissue to the spine, between the arches of adjacent vertebrae connected by ligamenta flava finally reaches the spinal canal: at first the epidural space→ through dura mater → subdural space → arachnoid → to subarachnoid space;
- drip of the cerebrospinal fluid from the inserted needle indicates the penetration into the subarachnoid space.
Links[edit | edit source]
Related articles[edit | edit source]
Sources[edit | edit source]
- PASTOR, J. Langenbeck's medical web page [online]. [cit. 2009]. <http://www.freewebs.com/langenbeck/>.
[edit | edit source]
- Osacká Petronela: Punkcie. Multimediálna podpora výučby klinických a zdravotníckych disciplín :: Portál Jesseniovej lekárskej fakulty Univerzity Komenského [online] 2.12.2011, posledná aktualizácia 15.12.2011 [cit. 2011-12-23] Dostupný z WWW: <https://portal.jfmed.uniba.sk/clanky.php?aid=169>. ISSN 1337-7396