SHM Converge Scientific Abstract ePoster Gallery-Possible Dry Tap, Hydrate Before the Lumbar Puncture?

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This study examined lumbar puncture (LP) outcomes performed by a Hospitalist Procedural Team at a large urban academic center from April 2023 to October 2024. Of 140 bedside LPs done without ultrasound guidance, 93 were successful and 47 were unsuccessful, giving a success rate of 66.4%.<br /><br />The authors found that higher body mass index (BMI) and complex spinal anatomy were linked to LP failure. Successful cases had an average BMI of 22.5, while unsuccessful cases had a higher average BMI of 27.5. Complex spinal anatomy, defined by prior lumbar surgery, scoliosis, or extensive degenerative changes, was present in 25.5% of unsuccessful cases but in none of the successful ones.<br /><br />A key focus was the possibility of “dry taps,” meaning no cerebrospinal fluid (CSF) is obtained despite apparently correct needle placement. Among the 47 failed LPs, 15 cases (31.9%) were concerning for dry tap. In several of these cases, neuro-radiology later obtained only minimal CSF (1–3 mL), and in four cases, reattempting the LP after hydration led to success. One case was not reattempted. There were no major complications, though minor superficial bleeding occurred in eight cases.<br /><br />The authors suggest that dehydration may contribute to dry taps, especially in hospitalized patients. They propose that checking BMI, reviewing spinal history/radiographs, and ensuring adequate hydration before LP could improve bedside LP success. For patients who are not at risk of volume overload, intravenous hydration before the procedure may be helpful. They also recommend future studies comparing bedside LP with same-day neuro-radiology attempts to better understand dry taps.

Asset Subtitle

Jung Eun Ha

Meta Tag

Author List Andrew S. Dunn, Farzad Marashi, Jung Eun Ha, Manan Shah, Seunghyup M. Baek, Vinh-Tung P. Nguyen

Category Research

Concept Lumbar Puncture

Concept Dry Tap

Concept Procedure Success

Concept Procedure Failure

Concept Body Mass Index

Distinguished Non-Finalist

Presenter Organization Division of Hospital Medicine, Mount Sinai Hospital

Presenting Author Jung Eun Ha

Track Quality Improvement

Keywords

lumbar puncture

bedside LP

hospitalist procedural team

procedure success rate

body mass index

spinal anatomy

dry tap

cerebrospinal fluid

hydration

neuro-radiology

Lumbar Puncture

Dry Tap

Procedure Success

Procedure Failure

Body Mass Index