Instruments and Procedures cannula/lumber puncture

INTRACATH / INTRAVENOUS CANNULA It is used for giving IV fluids and drugs—

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CANNULA

  • It consists of a long metallic: needle and a plastic can­nula or sheath over it.
  • The bevelled tip of the needle goes inside the vein and at the other end the blood leaking out can be seen.
  • The needle may then be withdrawn and the plastic cannula or sheath left in place for many days.

Indications —

  • · To withdraw CSF in cases of meningitis for diagnosis of etiology.
  • · Subarachnoid haemorrhage.
  • · GB syndrome – albumin cytological dissociation.
  • · Queckenstedt test for CSF block.
  • · For myelogram – for diagnosis of spinal tumors, disc prolapsed etc.
  • · Therapeutic use – Intrathecal administration of steroids, immunoglobulin’s, methotrexate etc.
  • · For Spinal anaesthesia.

The LP needle —


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LP needle

  • · It is a sharp needle with a short bevel (slanting tip), with a stilette fitting inside the needle.
  • · It is made of steel.

Lumber puncture Method —

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Lumber puncture Method

  • · The patient may sit up and bend forwards or lie in a lateral decubitus position with the knees drawn up on the abdomen and head fully flexed.
  • · In this position the back arches backwards and the intervertebral spaces are increased.
  • · The LP need Ie is inserted between the 3rd and 4th lumbar vertebra i.e. on a line joining the highest points of the two iliac crests.
  • · The patient is sedated, positioned, cleaned, draped and local anaesthetic xylocaine is injected subcutaneously at the site. LP needle is inserted with the stilette with the bevel of needle point­ing upwards, direct into the space till loss of re­sistance is felt when the needle passes through the dura. The stillete is removed and CSF is seen to trickle out. CSF is collected in 3 bottles about 2 ml each for biochemical test, culture sensitiv­ity and cytological examination.
  • · The needle is taken out after replacing the sti­lette and the site is sealed with tincture ben­zoin.
  • · The head end is lowered by raising the foot end.
Complications —-
  • · Dry tap – no CSF comes out.
  • · Traumatic LP
  • · Hypotension
  • · Headache
  • · Brain stem herniation
  • · Introduction of infection
  • · Backache.
Contraindications —
  • · Raised intracranial tension and papilledema
  • · Skin infection at the site of puncture
  • · Spinal cord compression
  • · Bleeding disorders
  • · Septicemia.

BONE MARROW BIOPSY —

  • Aspiration biopsy is done with a wide bore needle.

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Indications —-

  • · Anaemias
  • · Pancytopenia
  • · Purpuras
  • · Myeloid metaplasia
  • · Leukemias
  • · Multiple myeloma
  • · Lymphomas
  • · Kala azar
  • · Prog nostic.

Bone marrow biopsy needle —-

  • It is also called a sternal puncture needle.
  • The Salah’s needle consists of stout wide bore short bevelled needle With a stilette. On the side it has a screw guard which can be tightened at a particular distance from the tip to avoid over- penetration.

Site of Puncture

  • · The first part of body of sternum.
  • · Posterior Iliac crest.

Technique

 

    • · Sternal puncture
    • · Patient is mildly sedated. The sternum is cleaned and punctured opposite the second and third
    • intercostal spaces and ~ocal anaesthetic Xylocaig.e injected so as to infiltrate the periosteum whiCh is very sensitive to pain.
  • >· The aspiration needle is inserted vertically half cm. into the sternum. On entering the bone marrow loss of resistance is felt, stilette is re­moved and suction applied with a syringe to draw out 0.2 ml of marrow. The needle is withdrawn and puncture site is pressed and sealed with tinc­ture ben?:oin.
  • · Films are prepared from aspirate immediately.
  • · For posterior iliac crest puncture, the patient is in lateral decubitus position and the needle is introduced perpendicularly into the ilium at the posterior superior iliac spine.
  • Cutting fork

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Indications—

  • · For diagnosis of liver disease in jaundice
  • · Hepatitis
  • · Chronic hepatitis
  • · Cirrhosis and portal hypertension
  • · Unexplained hepatomegaly
  • · Abnormal LFT
  • · PUO
  • · Malignancies and lymphomas
  • · Metabolic diseases.

This is short description about some spatial processors’ in medical field, general practice.