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At least 19 recordsLinked to original sources
PubMed1993

[Lumbar puncture--the post-puncture syndrome. Prevention with an "atraumatic" puncture needle, clinical observations].

Postlumbar puncture syndrome (PPS) is caused by continuous leakage of CSF through the dural puncture defect. While it has long been known that the symptoms are dependent on the diameter of the puncture needle, the influence of the needle point on the frequency of PPS has now also been examined. Following diagnostic and/or therapeutic lumbar puncture (LP) with Sprotte's "atraumatic" needle, the symptoms in 600 patients during a period of 8 days were recorded. In 92% of the patients LP involved no problems. In 7% the puncture was successful only at the second or third attempt. In 4 cases it was necessary to carry out the procedure under X-ray control. While the literature shows that PPS following lumbar puncture with a 21 G needle occurs in 30-40% of cases, only 3.6% of the patients complained about position-dependent headaches where the Sprotte needle was used. Nausea, dizziness and tinnitus were extremely rare (< 1%).--The "atraumatic" puncture needle reduces the frequency and the degree of PPS to the minimum and makes the lumbar puncture procedure possible on an outpatient basis.

Adolescent↗
PubMed1977

Simultaneously obtained skin-puncture serum, skin-puncture plasma, and venous serum compared, and effects of warming the skin before puncture.

Specimens of skin-puncture serum and plasma and venous serum were simultaneously obtained from healthy adults and in each specimen the concentrations of 12 chemical constituents were measured. No clinically important difference was found in the concentrations of the constituents measured in skin-puncture serum and plasma with or without warming the skin before puncture. When the concentration of each of the measured constituents was compared in skin-puncture specimens and venous serum there were important differences in the concentrations of glucose, potassium, total protein, and calcium. Except for glucose, the concentrations of these were higher in venous serum. The degree of hemolysis was the same in skin-puncture serum and plasma, but less in venous serum. The greater hemolysis in skin-puncture specimens was not reflected in a clinically important increase in the values of lactate dehydrogenase and potassium. We conclude that there is a difference in the concentration of some chemical constituents in skin-puncture specimens and venous serum and that these differences should be considered when results for these types of specimens are compared.

Adult↗
PubMed1986

[Ultrasound-controlled puncture procedures: free-hand puncture versus transducer biopsy puncture. 5 years' experience].

To compare the accuracy of both ultrasound-guided puncture methods 417 patients were examined over a period of 5 years (retrospectively). Our results show no significant difference in accuracy between free-hand puncture and biopsy transducer puncture. It may be that puncture of very small (less than 2 cm) und very deep (greater than 8 cm) targets by biopsy transducer is a little more advantageous. In our opinion free-hand puncture is time-saving. Free-hand puncture allows a better visibility of the biopsy-needle artefact and is better practicable in case of anomalies of body structure. We did not observe complications worth mentioning with any of these two methods. We prefer free-hand puncture.

Biopsy, Needle↗
PubMed1998

Puncture technique and postural postdural puncture headache. A randomised, double-blind study comparing transverse and parallel puncture.

BACKGROUND: This clinical study was conducted in order to investigate the effect of two different orientations of the bevel during dural puncture on development of postural postdural puncture headache (PPDPH). METHODS: Two hundred and eighteen patients aged 18 to 50 years scheduled for minor non-obstetric surgery using spinal anaesthesia (SA) were included in this randomised, double-blind study. Dural puncture was performed using a 0.42 mm O.D. (27-g) Quincke spinal needle with the orientation of the bevel parallel or transverse relative to the longitudinal axis of the dural cylinder. All patients were blinded with regard to the puncture technique, and so was the anaesthesiologist performing a telephone interview 5 to 7 days postoperatively. The occurrence and duration of headache, backache and other complaints were recorded. Headache was classified as PPDPH or non-PPDPH, and intensity of the headache was registered using a numerical rating scale (NRS) from 0 to 10. RESULTS: Two hundred and twelve patients with a mean age of 35.3 years completed the study, 106 in each group. The two groups were comparable with regard to mean age, sex, local anaesthetics used and surgical procedure performed. Headache occurred in 44 patients postoperatively. PPDPH was diagnosed in 4/106 patients (3.8%) in the parallel group and 24/106 (22.6%) in the transverse group (P < 0.0002). Postoperative backache occurred in 31 and 20 patients (parallel compared to transverse) (NS). CONCLUSIONS: Dural puncture with the bevel of the needle transverse to the longitudinal axis of the dural cylinder gave significantly more cases of PPDPH than puncture with the bevel parallel to this axis even when using a 27-g Quincke needle. When using Quincke bevelled needles care must be taken to assure that the orientation of the bevel is parallel to the longitudinal axis of the dural sac.

Adolescent↗
PubMed2003

Resistance of double-glove hole puncture indication systems to surgical needle puncture.

Double-gloving has been shown to reduce conclusively the risk of operating room personnel's exposure to blood. Limiting risk of exposure to blood by double-gloving provides protection against the transmission of bloodborne diseases. Realizing the importance of double-gloving, a double-glove hole puncture indication system exists that accurately detects the presence of glove hole puncture in the presence of fluid. Once a glove puncture is recognized by this double-glove hole puncture indication system, it provides a warning to the surgeon to remove the punctured gloves, wash hands, and don a new, sterile double-glove hole puncture indication system. While accurately identifying the presence of glove hole puncture in the presence of fluid, this double-glove hole puncture indication system also has resistance to needle puncture superior to that of single gloves. It is the purpose of this study to document the resistance to needle puncture of latex and non-latex double-glove hole puncture indication systems using a reproducible experimental model. The resistance to needle puncture of the double-glove systems was significantly greater than that of the undergloves or outer gloves alone. The resistance to glove puncture of the non-latex and latex single and double-glove systems was significantly greater than those encountered by the latex single and double-glove systems, respectively. On the basis of their accuracy in detecting glove hole puncture, combined with their demonstrated superior resistance to surgical needle puncture as compared to single gloves, these latex and non-latex double-glove hole puncture indication systems are recommended for all surgical procedures.

Equipment Design↗
PubMed2001

Cecal ligation and puncture as a model of sepsis in the rat: influence of the puncture size on mortality, bacteremia, endotoxemia and tumor necrosis factor alpha levels.

BACKGROUND: Cecal ligation and puncture is a widely used experimental model of sepsis. AIM OF THE STUDY: The present study was aimed to evaluate the influence of the size of the cecal puncture on mortality, bacteremia, endotoxemia and plasma TNF-alpha levels. MATERIALS AND METHODS: Female Sprague-Dawley rats underwent cecal ligation and puncture, divided into the following groups, defined by the diameter of the cecal puncture: 0.5-cm blade incision (n = 25), 13-gauge (n = 25), 16-gauge (n = 25), 18-gauge puncture (n = 25) and 4 punctures with a 22-gauge needle (n = 25). A sham operation was performed in another 25 rats. Three animals of each group were sacrificed 5 h after the procedure for blood cultures as well as determination of plasma endotoxin and TNF-alpha. The remaining animals were followed up for a week after cecal ligation and puncture for evaluation of mortality. RESULTS: Five hours after cecal ligation and puncture, bacteremia was present in all animals, independently of the puncture size. Endotoxemia and plasma TNF levels tended to increase along with the diameter of the cecal puncture. Mortality gradually increased with the puncture size, from 27% with a 22-gauge needle to 95% with the blade incision. CONCLUSIONS: The severity of sepsis obtained with cecal ligation and puncture in rats can be easily modulated varying the size of the puncture.

Animals↗
PubMed2006

Nerve fiber ingrowth into scar tissue formed following nucleus pulposus extrusion in the rabbit anular-puncture disc degeneration model: effects of depth of puncture.

STUDY DESIGN: In vivo histologic study of nerve ingrowth in the rabbit anular-puncture disc degeneration model. OBJECTIVE: To examine innervation of intervertebral discs and surrounding tissues in the rabbit anular-puncture model with various magnitudes of injury. SUMMARY OF BACKGROUND DATA: A rabbit anular-puncture model of disc degeneration was recently established. However, to our knowledge, the neuropathologic changes in the degenerated disc and surrounding tissues in this model have not been examined. METHODS: Anular punctures with an 18-gauge needle at depths of 1 and 5 mm were randomly performed at the L2-L3 or L4-L5 discs in New Zealand white rabbits (n = 16; 3.0-3.5 kg). The degree of disc degeneration was followed radiographically, and was further evaluated by magnetic resonance imaging and histology at sacrifice 4 or 12 weeks after the puncture. To identify nerve ingrowth into the discs, the L2-L3 to L4-L5 discs were immunostained with an antibody against protein gene product 9.5, a general marker for nerve fibers. RESULTS: Significant decreases in disc height and signal intensity in magnetic resonance imaging were observed only in the 5 mm punctured discs (P < 0.05). In all the discs, including nonpunctured control discs, protein gene product 9.5-immunoreactive fibers were only occasionally observed in the outermost part of the anulus fibrosus. In the 5 mm punctured discs, nucleus pulposus tissues were extruded, and scar tissues formed outside the discs. No nerve ingrowth into the needle track lesion at the anular puncture site was observed. However, protein gene product 9.5-immunoreactive fibers were observed in scar tissues on the surface of the puncture site. This finding was more evident in the 5 mm than in the 1 mm punctured discs (P < 0.05). CONCLUSIONS: This study indicates that in the rabbit anular-puncture disc degeneration model, disc degeneration associated with a higher nerve growth into the scar tissue was more evident when induced by a 5 mm than a 1 mm puncture. Although nerve ingrowth was observed in the extruded disc tissue, nerve ingrowth into the outer anulus, which has been reported in patients with discogenic pain, was not observed during the short observation period in this disc degeneration model. The limitation in assessing pain by behavior analysis or histologic evaluation of nerve ingrowth should be considered. Further studies to identify a surrogate marker of pain should be encouraged.

Animals↗
PubMed2006

Effect of the introduction of a lumbar-puncture sticker and teaching manikin on junior staff documentation and performance of paediatric lumbar punctures.

BACKGROUND: Performing a lumbar puncture in an unwell child can cause anxiety in both the parent and the junior doctor. There is increasing evidence of post-lumbar-puncture complications in this age group. AIMS: To improve the documentation, consent for and technical performance of paediatric lumbar punctures to 100% of the required standard within 3 months. SETTING: The paediatric emergency department of a the Royal North Shore Hospital (University of Sydney, Sydney, Australia). PARTICIPANTS: Paediatric emergency staff, including residents, registrars and consultants. METHODS: Medical records of 40 consecutive children who had undergone a lumbar puncture in the 6 months before the introduction of the lumbar-puncture proforma were reviewed. After introduction of the proforma, the records of 25 consecutive patients were reviewed to assess changes in the outcome measures. Before introduction of the proforma, junior medical staff were instructed in the procedure using specialised lumbar puncture manikins (Baby Stap; Laerdel, USA). RESULTS: Before introduction of the proforma, the median number of documented indicators was 4, out of a maximum of 12. There was almost no documentation of parental consent, patient complications and analgesia. Introduction of the proforma resulted in a highly marked increase to a median of 12 documented indicators per patient (p<0.01, 95% confidence interval 6 to 8). CONCLUSIONS: The introduction of a lumbar-puncture proforma and formal teaching sessions using a paediatric manikin led to a marked improvement in the documentation of paediatric lumbar-punctures. Lumbar-punctures can be performed only by accredited medical officers who have achieved competency on the lumbar-puncture teaching manikin.

Child↗
PubMedDate not supplied

Post-dural puncture headache and other complications after lumbar puncture.

In pediatric hematology and oncology specialties, lumbar punctures are frequently performed for diagnostic and therapeutic purposes. Lumbar puncture is a procedure that is generally well tolerated with minimal adverse effects. However, adverse effects do occur. Post-dural puncture headache (PDPH) is the most common adverse effect after lumbar puncture. A better understanding of the pathophysiology of PDPH and attention to needle selection and technique may lessen the occurrence of PDPH. A review of the literature that addresses the variables associated with PDPH and its prevention are presented. Other adverse effects after lumbar puncture include dysesthesias, backache, transient radicular irritation, nerve palsies, infectious processes, herniation, and bleeding disorders. Although most adverse effects are mild and resolve without intervention, others require astute diagnosis and management. This review discusses the general principles in the clinical presentation of adverse effects after lumbar puncture and offers interventions for management. The prevention and the recognition and treatment of adverse effects is the role of the entire health care team that cares for children who require lumbar puncture. As such, implications for the role of nursing are essential before, during, and after a lumbar puncture and are briefly discussed.

Headache↗
PubMed1997

Central nervous side effects after lumbar puncture. A review of the possible pathogenesis of the syndrome of postdural puncture headache and associated symptoms.

The mechanism of central nervous side effects of lumbar puncture is reviewed on the basis of the literature. The most frequent adverse effect of lumbar puncture remains the postdural puncture headache; dysfunction of certain cranial nerves occurs less frequently. Laboratory studies have shown that the production rate of CSF. Several reports suggest that lumbar CSF leakage may affect the intracranial CSF volume. There are no reports of measurement of the intracranial pressure in patients with postdural puncture headache, but there are several indications of a reduced CSF pressure that may explain postdural puncture headache and vestibulocochlear dysfunction following lumbar puncture. Recent audiometric studies suggest that hearing loss may be a sensitive indicator of CSF leakage, and larger series indicate that the needle size and the shape of the needle tip are important determinants of the incidence of central nervous side effects. Epidural blood patch may give immediate relief of postdural puncture headache and cranial nerve dysfunction after lumbar puncture, but the reason for the rapid and impressive effect of epidural blood patch has not been fully elucidated.

Blood Patch, Epidural↗
PubMed1993

Double balloon mitral valvuloplasty through dual femoral vein punctures and a single atrial septal puncture.

A modification of a previously described double balloon mitral valvuloplasty procedure is described. This involves dual femoral vein punctures with a single atrial septal puncture. After initial transseptal catheterization and predilatation of the interatrial septum with an 8-mm balloon, a second catheter is advanced through the resulting atrial septal defect allowing access to the left atrium and left ventricle through the mitral valve via two separate femoral vein puncture sites. In comparison with the previously described technique using two balloon catheters inserted through a single femoral vein puncture site, this modification has reduced the amount of bleeding from the femoral vein and the need for transfusion. Furthermore, the potential for subsequent interatrial shunting is less than with the alternative previously described technique utilizing two femoral vein punctures with two separate punctures in the interatrial septum. In utilizing two separate femoral vein punctures with only one atrial septal puncture this technique combines advantages of the two previously described techniques.

Catheterization↗
PubMed1998

Post-dural puncture related complications after diagnostic lumbar puncture, myelography and spinal anaesthesia.

OBJECTIVES: This study was conducted to investigate complications after dural puncture. MATERIAL AND METHODS: A 15 months' prospective observation study of routine clinical practice with dural puncture at a university hospital was conducted. Quincke spinal needles 0.90 to 1.0 mm O.D. (20-19 g) were used for diagnostic lumbar puncture, 0.70 mm O.D. (22 g) for myelography and 0.40 to 0.50 mm O.D. (27-25 g) for spinal anaesthesia. A questionnaire about post-puncture discomfort was given to the patients, to be returned after 1 week. RESULTS: Of 679 questionnaires 537 (79.1%) were returned. Discomfort was experienced by 53.8% of the patients, most often after diagnostic lumbar puncture and myelography. The difference in incidence of headache after diagnostic lumbar puncture and myelography compared with spinal anaesthesia were 27.9% (95% CI: 18.6 to 37.2) and 18.3% (95% CI: 9.1 to 27.5). CONCLUSION: Small diameter and atraumatic spinal needles will reduce patients' discomfort after dural puncture.

Adult↗
PubMed2005

Detection of needle puncture to blood vessel using puncture force measurement.

Although blood sampling is frequently performed, a system to take blood samples automatically has not yet been developed. In the paper, as a first step towards automatic blood sampling, an examination of an automatic method for puncturing blood vessels is described. The force waveforms produced by puncturing rabbit ear veins were measured. A characteristic peak, possibly associated with the needle piercing the vessel wall, was observed in each waveform of ten successful cases of 14 trials. An algorithm that allowed the detection of this peak was developed, and parameters of a filter to improve the accuracy of the algorithm were determined. Using this algorithm, automatic needle punctures were performed in a rabbit ear vein and then were simulated using the data derived from manual needle puncture on four other rabbits. The results gave 30 fully successful cases of 33 trials of needle puncture and showed that measurement of the puncture force may be important for automatic needle puncture of blood vessels.

Animals↗
PubMed2000

Repeated lumbar or ventricular punctures for preventing disability or shunt dependence in newborn infants with intraventricular hemorrhage.

BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: To determine whether repeated CSF tapping, by lumbar puncture or ventricular tap, reduced the risk of permanent shunt dependence, neurodevelopmental disability or death in neonates at risk of, or actually developing, post-hemorrhagic hydrocephalus (PHH). This form of treatment was based on the hypothesis that repeated tapping removed protein and blood from the CSF, thus clearing obstruction from the channels of CSF absorption. SEARCH STRATEGY: Pediatric, Neurosurgical and General Medical Journals were handsearched from 1976, as well as the Medline database. Personal contacts were used. SELECTION CRITERIA: Four controlled trials ( with five published papers) were identified, three being randomised and the fourth using alternative allocation. Two trials evaluated repeated lumbar punctures in neonates with intraventricular hemorrhage (IVH) and two trials evaluated repeated CSF tapping infants with IVH followed by progressive ventricular dilatation. DATA COLLECTION AND ANALYSIS: In addition to details of the patient selection and patient allocation, the interventions were extracted. The end-points examined were: ventriculoperitoneal shunt, death, disability, multiple disability and death or disability. MAIN RESULTS: The studies were sufficiently similar in the question they were asking and the interventions were sufficiently in common that they could be combined when assessing the effect of the intervention. When repeated CSF tapping was compared to conservative treatment, the relative risks for shunt placement, death, disability and multiple disability were very close to 1.0 with no statistically significant effect. There is also evidence that this form of treatment increased the risk of CSF infection. REVIEWER'S CONCLUSIONS: Early repeated CSF tapping cannot be recommended for neonates at risk of, or actually developing, post-hemorrhagic hydrocephalus.

Cerebral Hemorrhage↗
PubMed2007

[Diagnostic lumbar puncture performed in the outpatient setting of a memory clinic. Frequency and risk factors of post-lumbar puncture headache].

Lumbar puncture (LP) is growing in relevance for the diagnosis of cognitive impairment in the elderly. Due to the expected risk of post-lumbar puncture syndrome or other complications LPs have rarely been performed in the outpatient setting. Using a questionnaire, the post-lumbar puncture symptoms of 100 patients (54-84 years old; mean: 68.87 years; SD: 7.9) have been prospectively gathered after consecutively performed LPs in the Memory Clinic of the Department of Psychiatry, University of Bonn. Some of these patients were included in the early diagnosis program of the German Dementia Competence Network. Of the patients 9% developed a post-lumbar puncture syndrome of mild or middle intensity. The influence of gender, age, cognitive status, as well as a supplementary diagnosis of depression and needle size (G20 or G22 atraumatic Sprotte needle) on the incidence of the post-LP syndrome was evaluated by means of logistic regression. Only the patients' age was identified as a significant risk factor as with increasing age a diminishing risk of developing a post-lumbar puncture syndrome was found (OR=0.83; CI=0.71-0.97 per year). None of the other factors evaluated proved to be of significant influence. The post-LP symptoms did not necessitate supplementary consultations in any of the cases.

Age Factors↗
PubMed1996

Repeated dural punctures increase the incidence of postdural puncture headache.

Previous studies have failed to find a significant correlation between the number of dural punctures and the incidence of postdural puncture headache (PDPH), questioning the hypothesis that leakage of cerebrospinal fluid (CSF) through the dural tear is the cause of PDPH. We hypothesized that insufficient statistical power of these studies was the cause for this unexpected finding, and re-examined whether repeated dural punctures increase the incidence of PDPH by analyzing prospectively collected data on 8034 spinal anesthetics. Uneventful spinal anesthetics, including a single subarachnoid injection of local anesthetics, occurred in 7865 (97.9%) cases, whereas failed spinal anesthetics requiring repeated dural puncture for a second subarachnoid injection of local anesthetics occurred in 165 (2.1%) cases. The two groups were similar with regard to age, sex, and ASA physical status. We found that repeated dural punctures significantly increased the incidence of PDPH. We conclude that increased risk of PDPH is a disadvantage of performing a second subarachnoid injection of local anesthetics after a failed spinal anesthetic. Moreover, this result suggests that leakage of CSF through the dural tear is the most plausible cause of PDPH.

Adolescent↗
PubMed1978

Lateral cervical puncture: an alternative to lumbar puncture.

As an alternative to lumbar puncture for acquisition of cerebrospinal fluid, lateral cervical puncture is simple to perform and appears to have less potential for major complications than suboccipital puncture. A small number of normal cerebrospinal fluid samples from lateral cervical puncture were analyzed and were within the normal range of fluid obtained by lumbar puncture.

Humans↗