Thaum lub tswv yim tsim thiab ntsuas tau txais ntau qhov kev mloog, qhov ntev ntawm tus txha caj qaum yog qhov tseem ceeb uas txiav txim siab ncaj qha seb tus txheej txheem puas ua tau. Ib rab koob txha caj qaum uas luv dhau yuav tsis ncav cuag qhov chaw subarachnoid, thaum ib qho ntev ntev dhau los ua tsis muaj zog thiab tswj tau yooj yim.

Spinal koob feem ntau yog tsim nyob rau hauv peb tus qauv ntev: 3.5 nti (90mm), 5 nti (125mm), thiab 7 nti (175mm). Qhov kev xaiv nyob ntawm yuav luag tag nrho ntawm tus neeg mob lub cev nqaij daim tawv thiab qib vertebral tau nkag mus.

Standard Lengths thiab lawv cov lus qhia:

• 3.5 nti (90mm):Feem ntau siv rau cov neeg mob menyuam yaus lossis cov neeg laus nyias nyias. Hauv cov menyuam yaus, qhov kev ncua deb ntawm daim tawv nqaij mus rau tus txha caj qaum yog qhov ntiav, ua rau ib rab koob luv dua thiab yooj yim dua los tuav.
• 5 nti (125mm):Lub workhorse rau feem ntau cov neeg laus lumbar punctures. Nws yog txaus rau qhov nruab nrab - tus neeg mob loj thaum ua tus qauv L3-L4 lossis L4-L5 kais.
• 7 nti (175mm):Koob "ntev". Qhov no yog qhov tseem ceeb rau cov neeg mob rog rog, qhov tuab ntawm cov ntaub so ntswg subcutaneous adipose tuaj yeem tsim daim tawv nqaij - mus rau -dura deb ntawm tshaj 10cm. Yog tsis muaj 7-nti koob, tus kws kho mob tsuas tuaj yeem ncav cuag lub hom phiaj. Nws kuj yog siv rau paramedian mus kom ze los yog nyob rau hauv cov neeg mob uas mob scoliosis uas yuav tsum tau ib tug ntev trajectory.

Lub luag hauj lwm tseem ceeb ntawm Introducer koob

Rau ntev thiab nyias koob (tshwj xeeb tshaj yog 25G thiab siab dua), tus neeg qhia tsis yog pab tau xwb - nws yog qhov yuav tsum tau ua. Tus qhia daws ob qhov teeb meem loj:

• Tiv thaiv kev khoov thiab tawg:Ntev, ultra-thin 26G lossis 27G koob yog hloov tau yooj yim heev. Sim thawb nws ncaj qha los ntawm cov tawv nqaij tawv thiab cov ligament supraspinous zoo li sim thawb lub noodle ntub los ntawm tawv. Lub koob yuav buckle, khoov, lossis txawm tawg. Tus qhia, luv luv, stout 18G lossis 19G koob, ua raws li cov lus qhia nruj. Nws yog thawj zaug tso rau hauv lub ligament interspinous, tsim kom ruaj khov "tunnel." Tus txha caj qaum hloov pauv tau dhau los ntawm qhov av no, tiv thaiv los ntawm cov rog uas yuav ua rau nws deform.
• Tshem tawm cov tawv nqaij ntsaws:Thaum tus txheej txheem koob hla ntawm daim tawv nqaij, nws tuaj yeem punch tawm ib qho me me ntawm cov epidermis. Yog hais tias daim tawv nqaij ntsaws no yog nqa mus rau hauv qhov chaw subarachnoid, nws tuaj yeem tsim cov hlwb epithelial, ua rau muaj qhov tsis tshua muaj tab sis loj heev: intraspinal epidermoid qog. Tus tswv koob koob pierces ntawm daim tawv nqaij ua ntej, thiab nws cov stylet raug tshem tawm ua ntej tus txha caj qaum yuav dhau mus. Tus txha caj qaum yeej tsis kov ntawm daim tawv nqaij, tshem tawm tag nrho txoj kev pheej hmoo ntawm kev cog cov tawv nqaij.

Clinical Pearls rau Kev Xaiv Ntev:

Ib txwm kwv yees qhov tob xav tau ua ntej. Palpate cov txheej txheem spinous thiab xav txog tus neeg mob BMI.

Thaum siv 7-nti koob, qhov ntev ntxiv sab nraum tus neeg mob ua rau lub hub tsis ruaj khov. Siv koj txhais tes tseem ceeb los tswj lub hub tiv thaiv tus neeg mob nraub qaum.

Tsis txhob thim rov qab cov stylet tag nrho rau hauv ib rab koob ntev, nyias yog tias nws tau muab tshem tawm, vim tias lub hau tuaj yeem yooj yim puas los ntawm kev ntes ntawm bevel.

Thaum kawg, mastering spinal needle length yog hais txog kev nkag siab tib neeg anatomical variability. Qhov muaj nyob ntawm qhov ntev sib txawv, ua ke nrog kev txawj ntse engineering ntawm tus neeg qhia, ua kom ntseeg tau tias cov txheej txheem tseem ceeb no tseem siv tau rau cov neeg mob ntawm txhua daim duab thiab qhov ntau thiab tsawg.