How to perform lung puncture

Lung puncture mainly determines the patient's disease condition through examination of the lungs, which has important diagnostic significance for later treatment. Before doing lung puncture examination, preparations must be made. Patients should take oral cough suppressants and avoid tension. If they are nervous, they can take sedatives. The puncture examination method is relatively simple, but of course, you should pay attention to some side effects.

Prepare

1. Check the coagulation time, platelet count and prothrombin time of the patient before puncture. Those who have coughs should take oral cough suppressants, and those who are too nervous should take sedatives. 2. Instruments and drugs: Prepare the biopsy kit, including sterile surgical drapes, 18-22G suction and cutting puncture needles, syringes, surgical blades, sterile test tubes, specimen bottles, and slides. Tissue specimen fixative, local anesthetic.

How to perform lung puncture

1. For lesions of the upper lobe and hilum, puncture is usually performed from the front in the supine position. For lesions of the lingula and middle lobe, puncture is usually performed from the side in the supine position. For lesions of the basal segment and dorsal segment of the lower lobe, puncture is usually performed from the back in the prone position. 2. Select the center of the lesion as the puncture level, and choose the shortest distance (vertical or horizontal distance) from the skin to the lesion as the puncture path, and pay attention to avoid blood vessels, interlobar fissures, and intercostal nerves. When the lesion is located in the posterior segment of the upper lobe apex, an oblique needle insertion is sometimes used to avoid the scapula and ribs. 3. Select the puncture point and path according to the location and size of the lesion shown by CT or fluoroscopy, and mark the puncture point with a marker or gentian violet. The skin at the puncture area is routinely disinfected, covered with a drape, and local anesthesia is performed. Under the guidance of CT or fluoroscopy, the puncture needle is inserted into the lesion, and the patient is asked to hold his breath during needle insertion. 4. After CT or fluoroscopy confirms that the puncture needle tip is in the center of the lesion and there is no necrotic area, pull out the needle core, connect the syringe for negative pressure suction, and pull up the puncture needle to perform multi-point fan-shaped sampling. For solid masses, a cutting needle can be used to obtain specimens. 5. Obtain specimens and send them for pathological examination.

Precautions

1. Postoperative care: Patients need to be observed for 2 to 4 hours after the puncture biopsy. If no abnormalities are found by fluoroscopy, radiography or CT scan, they can go home for observation. 2. Complications ① Pneumothorax: The most common complication. If the lungs are compressed by 20% and symptoms tend to worsen, chest venting treatment is required. ② Bleeding: Mild hemoptysis, advise to rest in bed, take diazepam orally or intramuscularly. Massive hemoptysis can be treated with hemostatic drugs such as vasopressin. ③Air embolism: rare but with serious consequences. During the operation, care should be taken to prevent penetration of the pulmonary vessels, and the cannula needle should be blocked with the needle stylet immediately after each aspiration to prevent air from entering. ④ Tumor metastasis: rare. The needle core should be properly protected by a cannula when the needle is removed to prevent the biopsy material from falling off along the needle track.