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

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• The needle may then be withdrawn and the plastic cannula or sheath left in place for many days.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 —

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 —

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 3^rd and 4^th 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.

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

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.