Aspiration Puncture

ASPIRATION PUNCTURE, the withdrawal of various contents from body cavities using various needles and trocars connected to apparatus containing rarefied air. The most commonly used apparatus is Potain's aspirator (see Aspirators) with its various modifications. After proper preparation of the patient's skin in the area where the aspiration puncture is intended and of the doctor's hands, a puncture is made toward the cavity directly through all layers, or a preliminary incision is made through the skin, subcutaneous tissue, in places through the muscle layer as well, and only then is the puncture performed. Most frequently, aspiration puncture is performed on the chest cavity to evacuate various kinds of fluids accumulated in the chest cavity (exudative pleurisy, hydro-, hemo-, chylo-, pyothorax) and air (pneumothorax). In some cases, it is necessary to perform a deeper puncture for the diagnosis of interlobar pleurisy, lung abscess, etc. The technique of aspiration puncture on the chest is as follows: after precise fixation of the injection site and preparation of the skin and equipment, expanding the intercostal space as much as possible (by the patient's position), the upper edge of the rib is palpated with the left hand, and, fixing the needle with the right hand, a quick insertion is made to the required depth, and then slow aspiration is performed. Second in frequency are punctures of the pericardium when various liquids and air are present within it (exudative pericarditis, hemo-, hydro-, chylopericarditis, pneumopericarditis). Aspiration puncture of the pericardium has been used for a long time; many different approaches have been proposed, with Woinitch's method being most recommended. Technique: a puncture of the skin and subcutaneous tissue is made, and then, having located the upper edge of the rib in the 4th intercostal space on the right with a finger and the tip of the needle, the needle connected to a vessel with rarefied air is carefully inserted immediately at the edge of the sternum. The depth of the injection should not initially exceed 1.5 cm; if no fluid is obtained, it is carefully advanced by 0.5 cm and in exceptional cases by another 0.5 cm. Aspiration puncture is also used for aspirating fluids from joints, the abdominal cavity (see Ascites), the urinary bladder, in hydrocele, etc. For aspiration puncture of a joint, it is necessary to grasp the joint with all the fingers of the left hand on the sides, pressing the contents evenly toward the injection site, which is best performed between the spread thumb and index finger. If the joint cavity contains septic contents, the injection is made directly without shifting the skin; with aseptic contents, it is better to shift the skin (to close the needle tract). Aspiration puncture of the urinary bladder was first performed in 1701. Now, aspiration puncture of the bladder is performed with a curved trocar up to 10-12 cm long (Fleurant). Technique: in the Trendelenburg position, 1.5 cm above the symphysis, a quick puncture perpendicular to the plane of the abdomen is made, then the handle of the trocar is raised somewhat so that it passes behind the symphysis. Other approaches for aspiration puncture of the urinary bladder—through the perineum, sideways along the urethra—have now been abandoned. Aspiration puncture is also used for hydrocele. Technique: the patient lies down, the position of the testicle is determined, which normally lies at the lower part of the posterior wall of the sac. Having fixed it with the left hand, an injection is made in the anteroinferior part of the hydrocele in a direction from bottom to top, passing parallel to the testicle. After releasing the fluid, a pressure bandage and a suspensory are necessary. (For aspiration puncture of the spinal canal, see Lumbar puncture).