What Are the Most Common Lumbar Puncture Complications?

It is a kind of diagnosis and treatment operation commonly used in clinic. Can be used to diagnose various inflammatory diseases of the central nervous system, vascular diseases, spinal cord diseases, suspected intracranial space occupying diseases, neurological diseases of unknown diagnosis, pneumo-cerebral and spinal angiography, etc. High drainage (decompression) and infusion of drugs to treat central nervous system diseases.

It is a kind of diagnosis and treatment operation commonly used in clinic. Can be used to diagnose various inflammatory diseases of the central nervous system, vascular diseases, spinal cord diseases, suspected intracranial space occupying diseases, neurological diseases of unknown diagnosis, pneumo-cerebral and spinal angiography, etc. High drainage (decompression) and infusion of drugs to treat central nervous system diseases.

Chinese name

lumbar puncture

Used for

treatment

Indication

Determine cerebrospinal fluid properties

Contraindications

Patients with signs of cerebral hernia

Lumbar puncture overview:

The operation method is that the patient bends to lie on the side and holds his knees with both hands to widen the lumbar kyphosis and widen the intervertebral space. Local routine disinfection, puncture after infiltration anesthesia. Generally, there is resistance when you pierce 4 ~ 5cm, and the resistance suddenly decreases. After that, the needle core is pulled out, and the cerebrospinal fluid drips out after turning the needle tail. Cerebrospinal fluid is taken according to different purposes and circumstances. Then insert the needle core, pull out the puncture needle, fix it with a sterile gauze block, and lie down on the pillow for 4-6 hours.

Before lumbar puncture, you should pay attention not to puncture if there is local skin, soft tissue, or bone inflammation; obvious intracranial pressure can not be punctured if there is a sign of cerebral hernia; those who are critically in shock or near shock cannot be punctured; have spinal cord compression disease, spinal cord function The critical state that has completely disappeared cannot be punctured. Prevention of headache, cerebral hernia and infection after puncture.

Purpose of lumbar puncture :

(1) For diagnosis: 1. Take cerebrospinal fluid for examination. 2. Measure cerebral pressure and understand the level of intracranial pressure. 3. Perform cerebrospinal fluid dynamics examination. 4. Perform spinal or air-brain angiography.

(B) for treatment: 1, drainage of cerebrospinal fluid. 2. Remove cerebrospinal fluid and reduce intracranial pressure. 3. Intrathecal injection of drugs to treat inflammation or tumor.

Treatment of subarachnoid hemorrhage with lumbar puncture

Brain damage secondary to subarachnoid hemorrhage often manifests as follows: (1) Blood coagulation at the base of the skull or intraventricular obstructs cerebrospinal fluid return, acute obstructive hydrocephalus occurs, and hemoglobin and hemosiderin are deposited on the arachnoid membrane Particles can also cause cerebrospinal fluid reflux to be blocked, resulting in hydrocephalus and ventricular dilatation; (2) subarachnoid red blood cell collapse explains chemical meningitis caused by the release of various inflammatory substances, and increased cerebrospinal fluid increases intracranial pressure; (3) Vasoactive substances and histamine released from blood can stimulate blood vessels and meninges, causing vasospasm; (4) Blood can stimulate the opening of calcium ion channels, cause intracellular metabolic disorders, and in severe cases can lead to neuronal apoptosis.

Cerebrospinal fluid therapy has the following effects: (1) can eliminate free kallikrein, 5-HT and other inflammatory substances in bloody cerebrospinal fluid, reduce the content of collagen in cerebrospinal fluid, reduce the stimulation of red blood cells to the subarachnoid space, The physical and chemical components gradually return to normal; (2) after the intracranial cerebrospinal fluid is drained, the intracranial pressure is reduced and the pain is relieved; (3) the dynamics of the cerebrospinal fluid is changed to promote the flow of the cerebrospinal fluid and reduce the occurrence of hydrocephalus, while avoiding arachnoid membrane Adhesions.

Lumbar puncture complications

(1) Problems with bloody cerebrospinal fluid:

The problem of bloody cerebrospinal fluid caused by the lumbar puncture needle accidentally injured the venous plexus in the spinal canal is one of the most common complications in lumbar puncture. It often occurs due to lack of experience, too deep needle insertion, and accidentally injured the venous plexus in the spinal canal. If it is not immediately identified, it is likely to be confused with pathological bloody cerebrospinal fluid. If bleeding due to puncture accidental injury can often stop on its own quickly, but individual patients with more bleeding, temporary symptoms such as low back and leg pain due to blood irritation, only need to give general symptomatic treatment.

(B) low intracranial pressure syndrome:

Low intracranial pressure syndrome is usually caused by excessively low intracranial pressure due to the excessive use of lumbar puncture needles, or premature operation after surgery, causing too much outflow of cerebrospinal fluid from the lumbar puncture needles on the meninges. According to the patient's severely increased headache when sitting, severe nausea, vomiting, or dizziness may be associated with it. When the patient is supine or with his head down, the headache can be relieved or relieved, and the diagnosis can be confirmed. The bedridden system that requires patients to lie on their backs for 6 hours after puncture is often prevented to prevent such complications.

(3) Sudden increase in symptoms of the original spinal nerve root and spinal cord:

After the lumbar puncture and drainage, the buoyancy of the cerebrospinal fluid and the cushioning effect are reduced, which promotes the compression of the spinal cord or spinal nerve root nearby by the lesion, causing the original symptoms of nerve root pain, paraplegia, and urination disorder to suddenly occur. Aggravated, especially in patients with spinal cord compression. It is more likely to occur in patients with high cervical spinal cord compression STDs. Vigilant dyspnea, even sudden respiratory arrest and other serious complications. Therefore, nurses should closely observe the patient when cooperating with the doctor's lumbar puncture. Breathing and pulse.

(D) the formation or exacerbation of cerebral hernia:

When the intracranial pressure is increased, more fluid is discharged at one time during lumbar puncture, or the bedridden system is not strictly adhered to after lumbar puncture, and such complications are more likely to occur. In severe cases, breathing can stop suddenly, unconsciousness or convulsions, and even the heartbeat stops immediately. This is due to the sudden change in the dynamics of cerebrospinal fluid pressure between the cranial cavity and spinal cavity after lumbar puncture and drainage. This complication can occur at the time of the puncture or within hours after the puncture. If the intracranial pressure is found to be high during the operation, the fluid should be stopped, and only the cerebrospinal fluid stored in the cerebrospinal fluid pressure tube can be used for the test. Patients were instructed to strictly follow the bedridden system after surgery, and they should observe changes in consciousness, breathing, pulse, blood pressure, pupils, and limb movements within 12 to 24 hours. If necessary, preventive hypertonic dehydration diuretics can be used to prevent the formation or exacerbation of cerebral hernia. If it happens, emergency measures should be taken immediately and reported to the doctor, with the head and feet high, artificial respiration, injection of breathing heartbeat stimulants, etc. Quickly assist the doctor in rescuing and reset the brain hernia.

(5) Injury of cauda equina:

Such complications are rare in clinical practice, and are mostly related to the fact that the puncture needle tip is far from the human midline or the spinal nerve root is accidentally injured. Symptoms such as numbness in the lower limbs, pain, or transient dysuria may occur, and often heal itself.

(6) Postoperative infection:

Postoperative infections were caused by inadequate disinfection of lumbar puncture instruments and articles. It is completely avoidable if strict adherence to aseptic techniques is followed.

(7) Deficiency meningitis:

This complication is quite rare. It usually occurs after the injection of irritating drugs into the spinal subarachnoid space. Except for headaches and mild meningeal irritation, patients can be distinguished from intracranial infections. It usually subsides by itself within 2 to 3 days after surgery.