diabetic puncture


Also found in: Dictionary, Thesaurus, Legal, Encyclopedia.

di·a·bet·ic punc·ture

a puncture at a point in the floor of the fourth ventricle of the brain that causes glycosuria.
Synonym(s): Bernard puncture

puncture

(pungk'chur) [L. punctura, prick]
1. A hole or wound made by a sharp pointed instrument.
2. To make a hole with such an instrument.

puncture of the antrum

Puncture of the maxillary sinus by insertion of a trocar through the sinus wall in order to drain fluid. The instrument is inserted near the floor of the nose, approx. 112 in (3.8 cm) from the nasal opening. See: antrotomy

Patient care

The antrum is irrigated with the prescribed solution (often warm normal saline solution) according to protocol. The character and volume of the returned solution and the patient's response to treatment are carefully monitored and documented. Ice packs are applied as prescribed for edema and pain; these are replaced by warm compresses as healing progresses. Assessments are made for chills, fever, nausea, vomiting, facial or periorbital edema, visual disturbances, and personality changes, which may indicate the development of complications.

arterial puncture

Placement of a needle or catheter into an artery to sample blood gases or blood pressure, or positioning of a catheter in the aorta or the heart.

cerebrospinal puncture

A puncture of the meninges to collect cerebrospinal fluid or to inject contrast media or medications. Puncture sites include the spaces around the spinal cord (lumbar puncture), the cisterna magna (cisternal puncture), or open fontanelles in infants (ventricular puncture).

cisternal puncture

A spinal puncture with a hollow needle between the cervical vertebrae, through the dura mater, and into the cisterna at the base of the brain. This is done to inject a drug as in meningitis or cerebral syphilis, to remove spinal fluid for diagnostic purposes, or to reduce intracranial pressure. It should be used as a source of spinal fluid only if fluid cannot be obtained by lumbar puncture. See: cerebrospinal fluid

CAUTION!

This procedure may be lethal if not done by one skilled in this technique.

diabetic puncture

Bernard puncture.

exploratory puncture

Piercing of a cavity or cyst in order to examine the fluid or pus removed.

heel puncture

A method for obtaining a blood sample from a newborn or premature infant.

CAUTION!

The puncture should be made in the lateral or medial area of the plantar surface of the heel, while avoiding the posterior curvature of the heel. The puncture should go no deeper than 2.4 mm. Previous puncture sites should not be used.
Enlarge picture
LUMBAR PUNCTURE
Enlarge picture
LUMBAR PUNCTURE
Enlarge picture
LUMBAR PUNCTURE

lumbar puncture

Abbreviation: LP
Gaining entry into the subarachnoid space of the meningeal sac below the end of the spinal cord, usually at the level of the fourth intervertebral space with a hollow needle. This procedure is done to obtain cerebrospinal fluid (CSF) for analysis, as in the diagnosis of severe headache or in suspected central nervous system infection or bleeding; to administer drugs to the brain or spinal cord (such as anesthetics or chemotherapeutic agents); or to relieve the CSF of excess pressure or fluid, as in pseudotumor cerebri. Synonym: spinal puncture; Quincke puncture; spinal tap See: illustration; cisternal puncture; headache; Queckenstedt sign

CAUTION!

Postprocedure headache occurs in about half of all patients who undergo lumbar puncture. Rarely reported complications of the procedure include cerebral herniation, epidural infection, epidural bleeding, paraparesis, and subdural bleeding.

Procedure

Informed consent for the procedure is obtained except in dire emergencies when clinical judgment prevails. Appropriate equipment is gathered: sterile gloves and mask for the operator, skin antiseptic (povidine-iodine solution), local anesthetic (1% lidocaine), and a lumbar puncture tray containing sterile gauze sponges, fenestrated drape and towel, needles and syringe for anesthesia, spinal needles, 4 collection tubes, 3-way stopcock and manometer; and a small adhesive bandage.

The procedure and expected sensations are explained, and the patient is asked to remain still when positioned and to breathe normally. The patient is typically placed on his or her left side at the right edge of the bed or examining table with knees drawn up to the abdomen and chin down to the chest, or in a sitting position with legs over one side of the table and buttocks at the other, bending head and chest toward the knees. Either of these positions exposes the back to the operator and provides spinal flexion, allowing easy access to the lumbar subarachnoid space. The assisting nurse holds the patient appropriately to secure this position (one arm around the neck, the other around the knees, or holding both shoulders bent forward). Draping provides warmth and privacy. Next, the patient's skin is prepared with antiseptic solution, and a sterile fenestrated barrier is placed over the proposed puncture site. Local anesthetic is injected, and then the spinal needle, with its stylet in place, is slowly advanced between the vertebra into and through the dura and arachnoid membranes. The stylet that fills the needle is removed, and initial measurements are made of the opening intracranial pressure (ICP) with a manometer. When the procedure is performed for diagnosis, about 8 to 10 ml of fluid are collected and sent promptly to the clinical laboratory for analysis of cell count, glucose, protein levels, cultures stains, and special studies. The closing pressure should then be read, the needle removed, and a small impervious adhesive dressing applied, sometimes with collodion to prevent CSF leakage. See: illustration

Complications

Pain at the puncture site, infection, bleeding, neurological injury, death, and post–spinal tap headaches are all potential complications. Of these, postural headache, caused by chronic leakage from the puncture site, is the complication most often brought to the attention of health care professionals. It may be treated with the injection of a small amount of the patient's own blood epidurally, to form a blood patch. See: cerebrospinal fluid

Patient care

The nurse assists the operator throughout the procedure by numbering and capping specimen tubes for laboratory examination and by applying jugular vein pressure as directed. Reassurance and direction are provided to the patient throughout the procedure, and the patient is assessed for adverse reactions (elevated pulse rate, pain radiating into the limbs, pallor, clammy skin, or respiratory distress).

After the procedure, the nurse assesses vital signs and neurological status, particularly observing for signs of paralysis, weakness, or loss of sensation in the lower extremities. If CSF pressure is elevated, the patient’s neurological status should be assessed every 15 min for 4 hr, if normal, every hour for 2 hr, then every 4 hr or as ordered. The puncture site should be checked hourly for 4 hr, then every 4 hr for 24 hr, assessing for redness, swelling, and drainage. To decrease the chance of headache, oral intake (for spinal fluid replacement and equalization of pressures) is encouraged, and the patient should remain in bed in a supine position or with the head elevated no more than 30° for 4 to 24 hr (per operator or institutional protocol). The patient should not lift his or her head but can move it (and himself or herself) from side to side. Noninvasive pain relief measures and prescribed analgesia are provided if headache occurs.

illustration

Quincke puncture

See: Quincke, Heinrich

spinal puncture

Lumbar puncture.

sternal puncture

Puncture of the sternum with a large-bore needle to obtain a specimen of marrow.

tracheoesophageal puncture

Abbreviation: TEP
A surgically created connection between the trachea and the esophagus for a patient who has had his or her voicebox (larynx) removed. It permits the patient to force air from the lungs through the windpipe into the esophagus, and from there out of the mouth in order to speak. A one-way valve (shunt) is placed into the tracheoesophageal opening. The patient learns to speak using the TEP with the help of a speech therapist.

ventricular puncture

Puncture of a ventricle of the brain in order to withdraw fluid or introduce air for ventriculography.

Bernard,

Claude, French physiologist, 1813-1878.
Bernard canal - the excretory duct of the head of the pancreas. Synonym(s): accessory pancreatic duct; Bernard duct
Bernard duct - Synonym(s): Bernard canal
Bernard puncture - a puncture at a point in the floor of the fourth ventricle of the brain which causes glycosuria. Synonym(s): diabetic puncture
Bernard syndrome - Synonym(s): Horner syndrome
Bernard-Cannon homeostasis - the set of mechanisms responsible for the cybernetic adjustment of physiological and biochemical states in postnatal life. Synonym(s): physiological homeostasis
Bernard-Horner syndrome - Synonym(s): Horner syndrome
Bernard-Sergent syndrome - Synonym(s): acute adrenocortical insufficiency