Lumbar puncture

The lumbar puncture is a Medical examination consisting in collecting the céphalo-rachidian Liquide (LCR), or liquid cérébro-spinal, to study it (cytological examination to seek cells, in particular the white globules, biochemical for the proportioning of glucose, proteins, of the ions bacteriological chloride, by the setting in culture to identify a possible germ in question and to carry out a Antibiogramme to know which Antibiotiques will be effective on this germ). It is an examination of a great diagnostic contribution, but which is not without side effects nor potential complications, and whose indication must always be carefully posed.

Procedure

The lumbar puncture can be realized only by a Médecin and is done under conditions of strict Asepsie. To limit the nausea S, the patient will be, if possible, with jeun 3:00 before the intervention. Moreover, a Local anesthesia can be realized to decrease the pain. It can be made either by a subcutaneous injection of a product anaesthetizing in the zone of puncture, or by the application of an anesthetic pomade on this same zone.

The patient is installed sat (or sometimes lengthened on the side), the roundest possible back in order to release the rachidian solid mass well. The point of puncture is located by the expert: it must be located between 4th and 5th, or between 3rd and the 4th lumbar Vertèbre (which corresponds to two intervertebral spaces where one is not likely to touch the Spinal-cord, of which the final cone is higher located). The located zone is carefully disinfected, the doctor is equipped with sterile gloves, before inserting a specific needle (long, fine, digs, and equipped with a removable stylet which blocks the light of the needle), on the line of centers, almost with the perpendicular of the skin, until to have crossed the Dure-mère (feeling of penetration resistance of the needle) and to be thus in contact with the LCR. The good position of the needle is checked by withdrawing the stylet, which must normally make drip the LCR at the end of the needle. When the position is good, the stylet is completely withdrawn, and the LCR collected in specific tubes (as many tubes as of examinations requested). Its aspect is analyzed (normally the liquid is transparent and colorless (in " water-of-roche"). The liquid must run out naturally and never not to be aspired (risk of hemorrhage). The taking away must be most minimal possible (some drops by tube) in order to minimize the side effects. The pressure of opening and closing of the céphalo-rachidian liquid can then be measured by adapting a column specific to the needle. The latter is then withdrawn after having positioned back the stylet (what would significantly decrease the headaches after puncture). A Pansement is set up. The patient will have to remain lengthened on the back for approximately 6 hours in order to ensure the obturation of the méningée brêche caused by the examination, under strict monitoring nurse and medical. The interest of this confinement is however probably limited

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