SHM Converge Scientific Abstract ePoster Gallery-Improved Lumbar Puncture Success Rates Using Ultrasound and a Paramedian Approach

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This retrospective cohort study evaluated whether standardizing an ultrasound-guided paramedian lumbar puncture (USPM LP) approach improved procedure success compared with the traditional landmark-guided midline (ML) technique in a hospital medicine procedure service.<br /><br />Over a 2-year period before training, 84 ML lumbar puncture attempts were recorded, with a success rate of 72.6%. In the period after USPM training, 185 attempts were performed, with a success rate of 85.4%. After adjusting for sex, age, BMI, and whether the procedure was for chemotherapy, the probability of a successful lumbar puncture was 13.58 percentage points higher with USPM than with ML. The odds of success were also significantly higher with USPM (OR 2.41). <br /><br />The increased success rate was accompanied by less frequent use of neuroradiology consultation (OR 0.44). Both approaches had similar coagulation profiles and similarly low complication rates, including traumatic tap, post-procedural blood patch, and epidural hematoma.<br /><br />The study authors note that the paramedian approach may be advantageous because it accesses the spinal canal through the wider interlaminar space, and ultrasound helps guide the more difficult needle angle. They conclude that for hospitalists and other proceduralists with ultrasound skills, incorporating a USPM approach into bedside lumbar puncture practice may improve success and reduce reliance on neuroradiology.

Asset Subtitle

Jacob J. Wagner

Meta Tag

Author List Aditya Kler, Andrew P.J Olson, Jacob J. Wagner, Justin Clark, Kiril Dimitrov, Kyle Rudser, Matthew Yocum, Omar Jibril, Swati Jain, Zach Lauer, Zachary Kaltenborn

Category Research

Concept Ultrasound-assisted paramedian lumbar puncture

Concept Lumbar Puncture

Concept Ultrasound Guidance

Concept Success Rate

Concept Paramedian approach

Distinguished Non-Finalist

Presenter Organization University of Minnesota

Presenting Author Jacob J. Wagner

Track Outcomes Research

Keywords

ultrasound-guided lumbar puncture

paramedian approach

midline technique

procedure success

hospital medicine

retrospective cohort study

neuroradiology consultation

spinal canal access

bedside procedure

complication rates

Ultrasound-assisted paramedian lumbar puncture

Lumbar Puncture

Ultrasound Guidance

Success Rate

Paramedian approach