Journal of Clinical Monitoring and Computing

, Volume 31, Issue 5, pp 1065–1072 | Cite as

Detection of spine structures with Bioimpedance Probe (BIP) Needle in clinical lumbar punctures

  • Sanna Halonen
  • Kari Annala
  • Juho Kari
  • Samuli Jokinen
  • Aki Lumme
  • Kai Kronström
  • Arvi Yli-Hankala
Original Research


Lumbar puncture is a relatively safe procedure, but some serious, even fatal, complications can occur. Needle guidance can increase puncture accuracy, decrease the number of attempts, and make the procedure easier. We tested the feasibility of a bioimpedance-based tissue-sensing technology for needle guidance in clinical use. The Bioimpedance Probe (BIP) Needle has a removable BIP stylet enabling measurement of bioimpedance spectra during the procedure. The BIP Needle is connected to a measurement device that uses tissue-classification software, and the device provides audiovisual feedback when it detects cerebrospinal fluid (CSF). We performed spinal anesthesia with the BIP Needle in 45 patients. The device performance and needle tip location were verified by an experienced anesthesiologist confirming CSF leakage. The device detected CSF in all cases (sensitivity of 100 %). Six cases with false detections lowered the specificity to 81 %, but in practice, most of these were easy to differentiate from true detections because their duration was short and they occurred during backward movement of the needle. The epidural spectrum differentiated as fatty tissue from surrounding tissues, but the ligamentum flavum was not clearly detectable in the data. The BIP Needle is a reliable tool for detecting CSF in lumbar puncture. It can make the puncture procedure smoother, as repeated CSF flow tests are avoided. The correct needle tip location is immediately detected, thus unnecessary needle movements close to spinal nerves are prevented. Physicians could benefit from the information provided by the BIP Needle, especially in patients with obesity or anatomic alterations.


Spinal anesthesia Bioimpedance Needle guidance Monitoring Cerebrospinal fluid Epidural 



We thank M Rorarius, Assoc Prof em, who was involved in designing the present clinical study. We also thank all participating patients and study nurses. Injeq Ltd provided BIP Needles and bioimpedance analyzer for the study.


This research was supported by the European Union through the European Regional Development Fund in frames of the research center CEBE and competence center ELIKO, and also by Estonian Research Council (IUT-19-11-2014).

Compliance with ethical standards

Conflict of interest

S. H., J. K., and K. K. are employees of Injeq Ltd, K. K. is a stakeholder of Injeq Ltd.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Hermanides J, Hollmann MW, Stevens MF, Lirk P. Failed epidural: causes and management. Br J Anaesth. 2012;109(2):144–54.CrossRefPubMedGoogle Scholar
  2. 2.
    Hyderally H. Complications of spinal anesthesia. Mt Sinai J Med. 2001;69(1–2):55–6.Google Scholar
  3. 3.
    Kang XH, Bao FP, Xiong XX, Li M, Jin TT, Shao J, Zhu SM. Major complications of epidural anesthesia: a prospective study of 5083 cases at a single hospital. Acta Anaesth Scand. 2014;58(7):858–66.CrossRefPubMedGoogle Scholar
  4. 4.
    Pitkänen MT, Aromaa U, Cozanitis DA, Förster JG. Serious complications associated with spinal and epidural anaesthesia in Finland from 2000 to 2009. Acta Anaesth Scand. 2013;57(5):553–64.CrossRefPubMedGoogle Scholar
  5. 5.
    Chin KJ, Perlas A, Chan V, Brown-Shreves D, Koshkin A, Vaishnav V. Ultrasound imaging facilitates spinal anesthesia in adults with difficult surface anatomic landmarks. Anesthesiology. 2011;115(1):94–101.CrossRefPubMedGoogle Scholar
  6. 6.
    Seeberger MD, Kaufmann M, Staender S, Schneider M, Scheidegger D. Repeated dural punctures increase the incidence of postdural puncture headache. Anesth Analg. 1996;82(2):302–5.PubMedGoogle Scholar
  7. 7.
    Kopacz DJ, Neal JM, Pollock JE. The regional anesthesia “learning curve”. What is the minimum number of epidural and spinal blocks to reach consistency? Reg Anesth. 1995;21(3):182–90.Google Scholar
  8. 8.
    Kalvøy H, Frich L, Grimnes S, Martinsen ØG, Hol PK, Stubhaug A. Impedance-based tissue discrimination for needle guidance. Physiol Meas. 2009;30(2):129–40.CrossRefPubMedGoogle Scholar
  9. 9.
    Trebbels D, Fellhauer F, Jugl M, Haimerl G, Min M, Zengerle R. Online tissue discrimination for transcutaneous needle guidance applications using broadband impedance spectroscopy. IEEE Trans Biomed Eng. 2012;59(2):494–503.CrossRefPubMedGoogle Scholar
  10. 10.
    Kalvøy H, Sauter AR. Detection of intraneural needle-placement with multiple frequency bioimpedance monitoring: a novel method. J Clin Monitor Comput. 2015;. doi: 10.1007/s10877-015-9698-3.Google Scholar
  11. 11.
    Mishra V, Schned AR, Hartov A, Heaney JA, Seigne J, Halter RJ. Electrical property sensing biopsy needle for prostate cancer detection. Prostate. 2013;73(15):1603–13.PubMedGoogle Scholar
  12. 12.
    Hernandez DJ, Sinkov VA, Roberts WW, Allaf ME, Patriciu A, Jarrett TW, et al. Measurement of bio-impedance with a smart needle to confirm percutaneous kidney access. J Urol. 2001;166(4):1520–3.CrossRefPubMedGoogle Scholar
  13. 13.
    Kari J, Annala K, Annus P, Seppä V-P, Kronström K (2015) A thin needle with bio-impedance measuring probe: tissue recognition performance assessed in in vivo animal study. Accessed 12 May 2015.
  14. 14.
    Grimness S, Martinsen ØG. Bioimpedance and bioelectricity basics. 2nd ed. London: Academic Press; 2008.Google Scholar
  15. 15.
    Ragheb T, Geddes LA. The polarization impedance of common electrode metals operated at low current density. Ann Biomed Eng. 1991;19(2):151–63.CrossRefPubMedGoogle Scholar
  16. 16.
    Schwan HP. Linear and nonlinear electrode polarization and biological materials. Ann Biomed Eng. 1992;20(3):269–88.CrossRefPubMedGoogle Scholar
  17. 17.
    Gabriel S, Lau RW, Gabriel C. The dielectric properties of biological tissues: II. Measurements in the frequency range 10 Hz to 20 GHz. Phys Med Biol. 1996;41(11):2251–69.CrossRefPubMedGoogle Scholar
  18. 18.
    Mirtaheri P, Grimnes S, Martinsen ØG. Electrode polarization impedance in weak NaCl aqueous solutions. IEEE Trans Biomed Eng. 2005;52(12):2093–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Duda RO, Hart PE, Stork DG. Pattern classification. 2nd ed. New York: John Wiley & Sons; 2012.Google Scholar
  20. 20.
    De Andrés J, Reina MA, Prats A. Epidural space and regional anesthesia. Eur J Pain Suppl. 2009;3(2):55–63.CrossRefGoogle Scholar
  21. 21.
    Baumann SB, Wozny DR, Kelly SK, Meno FM. The electrical conductivity of human cerebrospinal fluid at body temperature. IEEE Trans Biomed Eng. 1997;44(3):220–3.CrossRefPubMedGoogle Scholar
  22. 22.
    Gabriel C, Gabriel S, Corthout E. The dielectric properties of biological tissues: I. Literature survey. Phys Med Biol. 1996;41(11):2231–349.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Sanna Halonen
    • 1
    • 2
  • Kari Annala
    • 3
  • Juho Kari
    • 2
  • Samuli Jokinen
    • 4
  • Aki Lumme
    • 5
  • Kai Kronström
    • 2
  • Arvi Yli-Hankala
    • 4
    • 6
  1. 1.Department of Electronics and Communications EngineeringTampere University of TechnologyTampereFinland
  2. 2.R&D DepartmentInjeq LtdTampereFinland
  3. 3.Tampereen Lääkärikeskus LtdTampereFinland
  4. 4.Department of AnesthesiaTampere University HospitalTampereFinland
  5. 5.Pirkanmaan Sairaanhoitopiiri, Valkeakoski HospitalValkeakoskiFinland
  6. 6.Medical SchoolUniversity of TampereTampereFinland

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