Download - TOPIK :Lumbar Puncture (LP)
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Unit 4.4b : Sistem Saraf.TOPIK :Lumbar Puncture (LP).
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Definisi Lumbar Puncrure (LP):
Prosidur memasukkan jarum ke dalam ruang subsraknoid kanal spinal untuk mendapatkan cecair serebrospinal.
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4. Hidrosefalus (hydrocephalus).
Indikasi:
1. Meningitis.
2. Hemoraj serebral (subarachnoid hemorrhages -SAH).
3. Ensefilitis (encephalitis).
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4. Menyuntik bahan-bahan ke dalam ruang subaraknoid (pewarna X-ray bagi miologram dan ensefalogram, ubat spt antibiotik/analgesik/sitotosik).
Tujuan:
1. Mendapatkan spesimen CSF bagi membantu diagnosis (FEME dan C&S)
2. Mengukur tekanan CSF.
3. Melegakan tekanan yang tinggi.
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1.Set LP (sterile)2.Glove (sterile)3.Galopot bagi:• Larutan alcohol (antiseptic)• Tincture Iodine (antiseptic)• Swab & gauze (steril)
4.Siring & jarum suntikan
Persediaan:Peralatan
Bahagian atas troli:
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5.Sponge holding forceps (sterile)
6.Plain dissecting forceps (sterile)
7.Manometer spinal.
8.Tiub getah (steril).
Peralatan
Bahagian atas troli:
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1.Ubat-ubat.
2.Losyen antiseptik.
3.Gunting.
4.Elastoplas.
5.Mask.
6.Botol spesimen.
Peralatan
Bahagian bawah troli:
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7.LA (Xylocaine 1 – 2 %)8.Borang-borang & botol-botol specimen
serta labelnya9.Spray (Nobecutane / Opsite)10.Plastik.11.Bekas sisa klinikal.12.Bekas peralatan kotor.13.Dsb.
PeralatanBahagian bawah troli:
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Prosidur:
Langkah: Rasional:
Beri salam Dihargai.
Beri penerangan Kurangkan bimbang
Keizinan bertulis (borang kebenaran).
Prosidur perundangan
Sediakan pesakit:
Skrin Privasi
Baringkan pesakit ke posisi lateral di tepi katil dalam bentuk ‘C’
Membuka ruang vertebra ke 3 & 4.
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Prosidur:Langkah: Rasional:
Pastikan dagu pesakit sentuh dada.Rapatkan lutut pesakit ke abdomenKekalkan posisi pesakit dengan memeluk lututnya.
Memudahkan kemasukkan jarum.
Letakkan pelapik di bawah bahagian terlibat
Melindungi kawasan permukaan.
Dedahkan bahagian terlibat.
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Prosidur:Langkah: Rasional:
Bantu doktor dlm prosidur.Pastikan pesakit tidak bergerak semasa jarum dimasukkan ke ruang vertebra.
Elak kecederaan.
Perhatikan keadaan pesakit sepanjang prosidur.
Mengesan keadaan luar biasa.
Masukan spesimen ke dlm botol.
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Prosidur:Langkah: Rasional:
Bantu doktor balut luka tebukkan.
Elak pendarahan.
Pastikan pesakit baring supine selama 6 jam.
Imbangan tekanan CSF.
Selesakan pesakit & kemaskan peralatan.
Keselesaan / kebersihan.
Label spesimen / hantar ke makmal.
Memastikan spesimen betul semasa diperiksa.
Lakukan cerapan (tanda vital / aduan).
Perbandingan keadaan pesakit sebelum & selepas LP.
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Catatan:
1. Bagi kanak-kanak pergerakan perlu dihadkan dengan mengekal posisi bentuk ‘C’.
2. Untuk pemberian ubat, tambahkan peralatan:
•Siring 20ml•Jarum suntikan•Ubat-ubatan.
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Posisi tebukan:
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Posisi tebukan:
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Posisi tebukan:
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Posisi pesakit (dewasa):
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Posisi pesakit (dewasa):
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Posisi pesakit (kanak-kanan):
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Posisi pesakit (bayi):
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Kontraindakasi:
1. Tekanan intrakranium tinggi.
2. Sepsis setempat.
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Komplikasi:
1. Sakit bahagian yang dicucuk.
2. Sakit kepala.
3. Sepsis setempat.
4. Kebocoran CSF.
5. Kecederaan pada diska vertebra.
6. Kecederaan saraf – kelemahan / kelumpuhan.
7. Meningitis.