Puncture of bone marrow and other punctures in medical and diagnostic purposes
A puncture is called a puncture of the organ. The procedure is performed for diagnostic or therapeutic purposes.
Puncture of bone marrow
The patient is made to study it,donors - in order to obtain healthy biological material. Puncture exposed to such bones as the iliac, epiphysis of the tibia, heel, and also sternum. In adults, the iliac crest and sternum are most often involved in the study. Puncture of the bone marrow can be performed even in the spinous process of the vertebra of the lumbar region. Due to the smaller thickness and density of the sternum in children, its puncture in this area is very dangerous. In childhood (including the earliest), bone marrow puncture should be predominantly performed in the tibia (its upper third).
The procedure is performed with anesthesia, inaseptic conditions of the operating room. Puncture of the bone marrow is carried out in the position of the patient lying on his back. Using a hollow needle, the sternum is pierced at the level of the third rib. A special puncture needle is equipped with a disc-limiter to control the depth of the puncture.
Under a microscopea colored smear of the material taken. This allows us to identify the presence of atypical cells and other changes. If there are bloody impurities in the puncture, the blood is removed with the help of filter paper or aspirated with a pipette. This need is connected with the fact that an excessive admixture in the material of peripheral blood does not allow to obtain an accurate idea of the composition of the bone marrow. If the biological material is too liquid, a leuco-concentration method is used. After the cells are separated from the plasma, smears are made from the sediment.
Puncture (biopsy) of the bone marrow is carried out inthe purpose of diagnostic confirmation of metastases, finding out the causes of thrombocytosis, leukocytosis, anemia. This procedure also makes it possible to evaluate the effectiveness of the drug therapy used in blood diseases.
It is rare in medical practicecomplications with diagnostic puncture. As a rule, they can be associated with infection in the medullary cavity. When carrying out a sternum puncture, there is no chance of damage to large vessels. Only in the case of gross non-observance of the technique of investigation, violations in the integrity of internal organs are possible.
This procedure is used for extraction with subsequent investigation of the CSF or for infusion of radiopaque or drug substances.
During the procedure, the needle is inserted into the subarachnoidspace. Puncture can be performed at different levels of the spine. More often the puncture is carried out in the lumbar region, in rare cases in the thoracic region, near the large opening.
The lumbar puncture gives a veryvaluable diagnostic data. Liquor obtained during the procedure may contain bloody or purulent impurities. This makes it possible to assume meningitis or subarachnoid hemorrhage. The cerebrospinal fluid can also be transparent. Using a manometer (a glass tube bent at an angle, with existing centimeter divisions), it is determined by what pressure the liquor from the needle escapes: increased, normal, or decreased.
Puncture of the brain with hematomas
As practice shows, today, in comparison withpast years, this procedure has few indications. In particular, the need for a puncture in order to detect intracerebral hematoma (in the absence of CT) has significantly decreased. In the opinion of individual experts, one should not perform a puncture for this purpose because the procedure contributes to the aggravation of the damage, while usually hematomas are not detected.