7. PROCEDURE:
• PREMEDICATION : ATROPINE
SEDATION
• SUPINE WITH ARMS BEHIND HEAD AT
EDGE OF TABLE.
• STERILISATION & LOCAL ANESTHETIC
• SITE:9th OR 10th SPACE-MIDAXILLARY
AREA
• BIOPSY WITH NEEDLE
• LIVER TISSUE TO BE PUT IN FORMALIN
• T.B. SEAL
• VITALS FOR 4 Hrs & NBM TILL 4 Hrs
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8. CONTRAINDICATIONS:
• BLEEDING DIATHESIS
• SEVERE HEPATOCELLULARE JAUNDICE
• INFECTION OF LIVER,PERITONEUM,BILLIARY TRACT
RIGHT LUNG BASE, Rt. SUBHEPATIC ABCESS
• HYDATID CYST OF LIVER
• HEMANGIOMA OF LIVER
• CHRONIC PASSIVE CONGESTION OF LIVER
• GROSS ASCITES
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10. 2.LUMBER PUNCTURE
• NEEDLES: L-P NEEDLE
SHORT 21-23 GAUGE FOR
INFANTS
LONG 21 GAUGE FOR
CHILDREN
• INDICATIONS:DIAGNOSTIC
THERAPEUTIC
CHEMOTHERAPY
• ANTIBIOTICS
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12. PROCEDURE:
• POSITION: KNEE DRAWN UP & HEAD FLEXED
RESTRAIN IN LATERAL RECUMBANT POSITION
• SITE:INTERSPACE BETWEEN L3-L4 OR L4-L5
• SMALL INFANTS:SITTING WITH LEANING FORWARD POSITION
• STERILISATION & LOCAL ANESTHESIA
• ‘GIVE UP’ SENSATION – DURA PIERCED.
• T.B.SEAL
• HEAD LOW POSITION POST PROCEDURE.
• VITAL MONITORING
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15. COMPLICATIONS
• Headache (reduced by keeping head low or
plenty of fluids)
• Backache
• Infection
• Medullary herniation
• Injury to blood vessels,spinal cord or
intervertebral disc
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17. • POSITION ---- sitting with leaning forward
supine in small infants
• SITE----Fifth to sixth intercostal space in posterior axillary line
• PREMEDICATION----atropine and sedation
• Sterlization and local anesthesia
• Large 18-22 G Needle for centesis and mallecot or ICD tube
for drainage
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3.THORACOCENTESIS
23. PROCEDURE
• SUPINE or SEM RECLINED position with back rest
• SITE-midway between umblicus and anterior
superior iliac spine
• Evaluate bladder
• PREMEDICATION – atropine and sedation
• Sterlisation and local anesthetic
• Large bore needle or IV canula using ‘Z’ technique
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24. continue
• Don’t remove large volume or too rapidly-will
precipitate shock
• Tincture Benzoin seal
• Vitals monitoring
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25. complications
• SHOCK-if too rapid removal or large volume is
tapped
• Acute liver cell failure and precipitation of
hepatic coma
• INFECTION –peritonitis
• Perforation of visceral organ
• Protein depletion
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29. PROCEDURE
• SITE
ANTERIOR-fifth ICS outside apex but inside
outer edge of dullness
EPIGASTRIC(PREFERRED) - between
ensiform cartilage and left costal margin
POSTERIOR- near inferior angle of scapula
STERNAL-fourth left ICS lateral to sternum
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30. continue
• SUPINE POSITION
• PREMEDICATION- atropine and sedation
• Sterlisation and local anesthetic
• Epigastric lateral to xiphoid cartilage at 45degree
posteriorly towards MCL with negative suction
• Cardioscope should be attached
• Seal with tincture Benzoin
• Vitals monitoring
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36. SITES
• ILIAC CREST
- 1 cm below iliac crest about 1-2cm posterior
to mid axillary line
-prone or side position
-PREFERRED OVER TWO YEARS
TIBIA
-Upper third of medial shaft
-PREFERRED LESS THAN 2 YRS
STERNUM
LUMBAR SPINOUS PROCESS
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37. PROCEDURE
• Position
• Pre medication
• Local upto periostium
• Nick with screwing motion
• NEEDLES-21G LP needle for infants
18-19G marrow needle for older children
loss of resistance after entering cavity
attach to 10-20cc syringe with negative suction
Immediately make slide
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38. Post procedure
• LOCAL PRESSURE FOR 5 MINS
• Seal
• vitals monitoring
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39. COMPLICATIONS
• DRY TAP Faulty technique
Pathological marrow
- myelofibrosis
-myelosclerosis
-leukemia
-hyper or hypoplasia
Bone pain
Hematoma
Infection(osteomyelitis)
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40. WHAT TO LOOK FOR IN MARROW
• Number and type of
erythropoietic, megakaryocytic and
leucopoietic cell linenage
• Cellularity
• Myeloid erythroid ratio(normal 3:1 to 4:1)
• Tumor and plasma cells
• Parasites,LD bodies,malarial parasites
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