Special punctures | Puncture

Special punctures

A puncture of the knee joint may be indicated for two different reasons. On the one hand, to drain a possible joint effusion and to examine it if necessary. Whether this is clear, purulent or rather bloody can provide important information about the cause and thus enable a targeted treatment.

Pain can be directly relieved by relieving the pressure. On the other hand, by puncturing the knee, a medication can be injected into the joint in a targeted manner, which can be an option when treating pain, for example. In any case, the potential benefits of puncturing the knee joint should outweigh the risks.

Every puncture in a joint can lead to injury and infection, which can also worsen the patient’s condition. A very special type of puncture is required for intracytoplasmic sperm injection (ICSI) in the context of artificial insemination. Before the puncture is performed, the woman receives hormone treatment that stimulates the growth of several follicles in the ovary.

After about 10 to 12 days, ovulation is triggered by another hormone. Two days after this hormone is administered, the actual puncture is performed. In this case, the egg is retrieved with a long needle.

This is advanced through the vagina under ultrasound guidance. The procedure is usually performed under a short anaesthetic and takes about 10 to 15 minutes. It is necessary for the man to give his sperm on the same day.

A single sperm is then inserted into the retrieved eggs in the laboratory. If fertilisation is successful, the cells divide in the incubator over the following days until the vesicle stage. Then often two of these early embryos are transferred into the uterus.

In about 25 to 30% of cases, ICSI leads to pregnancy.It is possible to puncture the lung and take tissue samples. This may be considered, for example, if a conspicuous structure has been discovered in imaging (e.g. computer tomography) and one wants to examine it more closely. Depending on the location of the puncture target, the procedure can be performed either from the outside through the chest wall or from the inside through the airways.

In the latter case, the puncture is performed as part of a lung endoscopy (bronchoscopy). More often, however, it is not the lung that is punctured directly but the gap between the lung membrane and the pleura, which is called the pleural gap. This usually contains only a very small amount of fluid.

Due to various diseases, an effusion and thus an accumulation of fluid in the pleural gap can occur, which can even lead to impaired breathing. By means of pleural puncture, the effusion can be drained and, if necessary, a sample can be examined to find the cause of the water accumulation. Both direct pulmonary puncture and pleural puncture may cause air to enter the pleural gap.

As a result, the punctured lung may collapse. This is called a pneumothorax and must be treated as an in-patient in hospital. A puncture of the breast is usually performed if a conspicuous structure (for example, a lump) is to be examined.

This can be conspicuous, for example, in the course of a breast cancer screening examination. The puncture is usually intended to clarify whether the structure is benign or malignant. In most cases, breast puncture is carried out using fine needle puncture.

During this procedure, tissue and cells are removed from the breast using a special, very thin hollow needle. The examination is usually no more painful than taking a blood sample. A local anaesthetic is therefore usually not necessary.

The results are often available the same day. An alternative is the punch biopsy, in which a slightly larger needle is used to remove a small bridge of tissue from the breast. A puncture of the hip joint can be considered if there is an effusion in the joint.

Puncture of the hip joint can reduce the pressure in the hip and thus relieve pain. On the other hand, the fluid removed can be examined for the presence of bacteria, for example. In addition, hip joint puncture can also be used for the local application of medication, for example to treat pain.

An abdominal puncture is performed in the event of a pathological accumulation of fluid in the abdominal cavity. This is also known as ascites or dropsy. It is also used in cases of severe liver dysfunction, for example as a result of inflammation of the liver (hepatitis) or excessive alcohol consumption.

Cancer of the abdominal cavity can also lead to ascites. Depending on the extent, the amount of fluid can be several liters and lead to restricted movement and breathing difficulties. On the one hand, ascites puncture serves to directly relieve the pressure by draining some of the fluid from the abdomen.

On the other hand, a sample can be examined to obtain information about the cause of the abdominal dropsy. To avoid damaging organs such as the intestine or liver, the puncture can be performed under visual control using ultrasound. A liver puncture is used to remove tissue (biopsy) to examine diffuse or circumscribed liver changes.

The puncture is primarily used to confirm the diagnosis if the patient’s blood values and symptoms have already led to a suspected diagnosis. The puncture is performed through the skin using ultrasound. Compared to other abdominal organs, the liver can be reached relatively easily with the puncture needle.

Nevertheless, abdominal organs or the lung can be injured. By taking samples, the tissue can be examined for inflammatory or malignant changes, for example. The following, among others, are indications against puncture: the presence of a hepatic hemangioma, jaundice due to an obstruction in the bile ducts or a severe blood clotting disorder.

A cerebrospinal fluid or liquor puncture is necessary, for example, if there is a suspicion of an inflammatory disease of the central nervous system. In most cases, the puncture is performed in the area of the lumbar spine. This is then also referred to as a lumbar puncture.

The patient sits for the procedure and bends the upper body forward as far as possible.Alternatively, the puncture can also be performed while lying down. With a long thin needle, the physician punctures between two vertebral bodies up to the spinal canal. A sample of cerebral fluid can then be taken from the spinal canal.

In the area of the lumbar spine there are only nerve fibers but no spinal cord, so that the spinal cord cannot be injured. However, short-term sensations in the legs can occur when the needle touches a nerve fiber. In addition to diagnostic use, the puncture of cerebral fluid is also used in cases of overproduction of cerebrospinal fluid. The procedure can relieve possible symptoms such as headaches and walking disorders.