Puncture is a puncture of an organ. The procedure is carried out for diagnostic or therapeutic purposes.
Bone marrow puncture
Patients are made for its research, donors - in order to obtain healthy biological material. Such bones as the ileum, the tibial epiphysis, the calcaneus, and also the sternum are pierced. In adults, iliac crests and sternum are most often involved in the study. Bone marrow puncture can be performed even in the spinous process of the lumbar vertebra. 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 mainly be carried out in the tibia (its upper third).
The procedure is performed with anesthesia, in aseptic conditions of the operating room. Bone marrow puncture is performed in the position of the patient lying on his back. With the help of a hollow needle, the sternum is pierced at the level of the third rib. A special puncture needle is equipped with a stop disc in order to regulate the puncture depth.
Under the microscope, a colored smear of the taken material is studied. This allows you to detect the presence of atypical cells and other changes. If the punctate contains bloody impurities, the blood is removed with filter paper or aspirated with a pipette. This need is due to 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 obtained is too liquid, the method of leukoconcentration is used. After separation of cells from plasma, smears are made from the pellet.
A bone marrow puncture (biopsy) is carried out in order to diagnose metastases in a diagnostic manner, to clarify the causes of thrombocytosis, leukocytosis, and anemia. This procedure also allows you to evaluate the effectiveness of the applied drug therapy for blood diseases.
Complications with diagnostic puncture are quite rare in medical practice. As a rule, they can be associated with infection in the bone marrow cavity. When conducting a sternal puncture, there is no chance of damage to large vessels. Only in the case of gross non-compliance with the research technique are possible violations in the integrity of the internal organs.
Spinal puncture
This procedure is used to extract with subsequent examination of the cerebrospinal fluid or for the injection of radiopaque or medicinal substances.
During the procedure, the needle is inserted into the subarachnoid space. Puncture can be performed at various levels of the spine. Most often, a puncture is performed in the lumbar region, in rare cases in the thoracic region, in the area of a large opening.
Lumbar (lumbar) puncture provides very valuable diagnostic data. The liquor obtained during the procedure may contain bloody or purulent impurities. This suggests meningitis or subarachnoid hemorrhage. Cerebrospinal fluid may be transparent. Using a manometer (a glass tube bent at an angle with the available centimeter divisions), it is determined under what pressure the cerebrospinal fluid flows out of the needle: elevated, normal or reduced.
Brain puncture for hematomas
As practice shows, today, in comparison with previous years, this procedure has few indications. In particular, the need for a puncture was significantly reduced in order to identify intracerebral hematoma (in the absence of CT). According to some experts, a puncture should not be carried out for these purposes because the procedure contributes to the aggravation of damage, while hematomas are usually not detected.