SHM Converge Scientific Abstract ePoster Gallery-Success and Safety of Lumbar Punctures Performed by a Medicine Procedure Service

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This retrospective study reviewed all patients referred to the University of North Carolina Medicine Procedure Service for lumbar puncture from January 1, 2019 to December 31, 2020. The goal was to identify patient- and operator-related factors associated with two outcomes: successful cerebrospinal fluid (CSF) collection and traumatic tap, defined as CSF red blood cell count ≥1000/mm³.<br /><br />A total of 562 lumbar punctures were analyzed, mostly performed by trainees in an academic medicine procedure service. Manual chart review was used to gather variables, and both univariable and multivariable analyses were performed. Variables with p < 0.20 in univariable testing were entered into multivariable models.<br /><br />Key findings were:<br />- CSF was successfully obtained in 79.4% of procedures.<br />- 83% of lumbar punctures were ultrasound-assisted.<br />- 86.6% involved a resident operator.<br />- Obesity, performing the procedure with the patient lying down, and a higher number of passes were significantly associated with failure to obtain CSF.<br />- Ultrasound use was not associated with higher overall success in obtaining CSF.<br />- Ultrasound use was the only factor associated with lower odds of a traumatic tap.<br />- The most common complication was post-dural puncture headache, occurring in 4% of cases.<br />- Other complications were uncommon and included transient radicular pain, puncture-site tenderness, and severe back pain.<br /><br />The authors concluded that trainee-led lumbar punctures on an academic medicine procedure service had a high success rate and low complication rate. They also noted that cases referred onward to radiology had a subsequent success rate of 88%. Further analysis is planned, including the effect of operator experience and ultrasound use on the number of passes required.

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Ria Dancel

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Author List Andrew J. Donohoe, Andrew Short, Ann Marie Kumfer, Ashmita Chatterjee, Carlton Moore, David Hemsey, Erin E. Dunneback, Erin M. Finn, Hillary B. Spangler, Jeremy Halbe, Jessica Guidici, John R. Stephens, Jonathon Heath, Michael R. Contarino, Ria Dance

Category Research

Concept Lumbar Puncture

Concept Cerebrospinal Fluid Acquisition

Concept Traumatic Lumbar Puncture

Concept Medicine Procedure Service

Concept Learner Participation

Distinguished Non-Finalist

Presenter Organization University of North Carolina

Presenting Author Ria Dancel

Track Patient Safety

Keywords

lumbar puncture

cerebrospinal fluid

traumatic tap

ultrasound-assisted

trainee-led procedures

academic medicine

obesity

procedure success

post-dural puncture headache

multivariable analysis

Lumbar Puncture

Cerebrospinal Fluid Acquisition

Traumatic Lumbar Puncture

Medicine Procedure Service

Learner Participation