From Big Medical Encyclopedia

PUNCTURE (Latin. punctio prick) — a puncture of fabrics a hollow needle or a trocar with the diagnostic or medical purpose.

Diagnostic Items. make: 1) at a puncture biopsy for the purpose of receiving material (fabric, patol, liquids, blood) from different bodies, vessels, cavities or patol, educations (especially tumors) for macroscopic assessment, histologic, cytologic and other researches; 2) for administration of radiopaque substances in spongy substance of a bone, vessels (at an aortografiya, arteriography, a flebografiya, a limfografiya), cavities (at a plevrografiya, an artrografiya, an abstsessografiya); 3) for introduction to vessels of substances, marked radioisotopes for the purpose of measurement of volume of the circulating blood and its components or definition of function and topography of some bodies (see Scanning); 4) for tonometry in large vessels or cavities (e.g., in cameras of heart, a pleural cavity, subarachnoid space of a spinal cord); 5) for introduction to cavities of optical tools (e.g., the thoracoscope, a laparoskop) for the purpose of survey of the bodies which are in them and carrying out various researches (e.g., a puncture biopsy of a liver, a holetsistokholangiografiya, etc.); 6) for administration of gas in cavities (pheumothorax, a pneumoperitoneum) or kletchatochny spaces (a retropneumoperitoneum, a pneumomediastinum) for the purpose of the best contrasting of the bodies and educations which are in them at rentgenol, a research.

In the medical purposes P. apply: 1) for administration of medicines in fabric (in thickness of skin, under skin, in muscles), in cavities or vessels, during the carrying out a local anesthesia, novocainic blockade, etc.; 2) for injection of blood, its components or blood substitutes; 3) for receiving blood at donors and at some diseases (e.g., poisonings, hemolitic jaundice at newborns); 4) for removal from cavities patol, contents (gas, pus, the streamed blood, ascitic liquid); 5) for bladder emptying at impossibility of its catheterization.

At P.'s carrying out strict observance of rules of an asepsis is necessary (see). In alleged P.'s zone shave off hair, process leather an antiseptic agent. The item of superficially located veins make without anesthesia more often, P. of deeply located educations make under a local anesthesia solution of novocaine, and sometimes under anesthetic.

Make P. hollow needles of various length and diameter with mandrin or without it (see. Eagles medical ). (At ascites, total pio-or a hemothorax) it is better to make a puncture for removal of a large amount of liquid a trocar (see. Surgical tools ). At P. of abscesses in order to avoid formation of the direct channel on the course of a needle it is necessary to shift skin previously. Not to allow hit of air in a cavity during P., use special needles with cranes or rubber tubes. The tube connecting the syringe and a needle at the time of removal of the syringe is blocked a clip. For suction of a large number of contents it is possible to use the devices creating vacuum in system of tubes (see. Aspirators ). P.'s technique is various depending on the purpose of manipulation and the field of its carrying out.

The most frequent complications at P. are hematomas in a zone P. which do not demand treatment. However also heavier complications (suppuration, damage of bodies, a gap and thrombosis of vessels, massive bleeding) are possible for which elimination an operative measure can be required.

See also Biopsy , Venipuncture , Pleurocentesis , Sternal puncture , Suboktsipitalnaya puncture , Tympanopuncture .

Bibliography: Dymarsky L. Yu. Breast cancer, M., 1980; Kiri of l-l about in M. Yu. Aspirating needle, Klin, hir., No. 1, page 70, 1979; Kornev P. G. Surgery of bone and joint tuberculosis, p. 2, L., 1971; L about z and V. S. and Tsinova P. E N. Medical and diagnostic punctures and blockade in neuropathology, L., 1973.

A. M. Khokhlov.