Skip to main content

Point-of-Care Ultrasound: Guidance for Lumbar Puncture

  • 540 Accesses

Abstract

Ultrasound guidance is considered to be a best practice for many ICU procedures. While less commonly used to assist with lumbar puncture, certain patients, particularly those with poorly palpable lumbar landmarks or failed attempts, can benefit from anatomical localization with ultrasound. Use of bedside ultrasound to identify an ideal location for needle entry may prevent repeated attempts and reduce procedural complications. A simplified two-step ultrasound approach that maps the correct lumbar interspinous space and the true anatomic midline can make a blind procedure safer and more successful.

Keywords

  • Ultrasound
  • Lumbar puncture
  • Ultrasound guidance
  • Imaging
  • Point-of-care

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-81419-9_58
  • Chapter length: 12 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   219.00
Price excludes VAT (USA)
  • ISBN: 978-3-030-81419-9
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Hardcover Book
USD   279.99
Price excludes VAT (USA)
Fig. 58.1
Fig. 58.2
Fig. 58.3
Fig. 58.4
Fig. 58.5
Fig. 58.6
Fig. 58.7
Fig. 58.8

References

  1. Williams P, Tait G, Wijeratne T. Success rate of elective lumbar puncture at a major Melbourne neurology unit. Surg Neurol Int. 2018;9:12.

    CrossRef  Google Scholar 

  2. de Filho GR, Gomes HP, da FMH, Hoffman JC, Pederneiras SG, Garcia JH. Predictors of successful neuraxial block: a prospective study. Eur J Anaesthesiol. 2002;19:447–51.

    CrossRef  Google Scholar 

  3. Edwards C, Leira EC, Gonzalez-Alegre P. Residency training: a failed lumbar puncture is more about obesity than lack of ability. Neurology. 2015;84:e69–72.

    CrossRef  Google Scholar 

  4. Stiffler KA, et al. The use of ultrasound to identify pertinent landmarks for lumbar puncture. AJEM. 2007;25:331–4.

    CrossRef  Google Scholar 

  5. Shah KH, McGillicuddy D, Spear J, Edlow JA. Predicting difficult and traumatic lumbar punctures. Am J Emerg Med. 2007;25(6):608–11.

    CrossRef  Google Scholar 

  6. Gottlieb M, Holladay D, Peksa GD. Ultrasound-assisted lumbar punctures: a systematic review and meta-analysis. Acad Emerg Med. 2018;26(1).

    Google Scholar 

  7. Shaikh F, et al. Ultrasound imaging for lumbar punctures and epidural catheterisations: systematic review and meta-analysis. BMJ. 2013;346:f1720.

    CrossRef  Google Scholar 

  8. Perlas A, Chaparro LE, Chin KJ. Lumbar neuraxial ultrasound for spinal and epidural anesthesia: a systematic review and meta-analysis. Reg Anesth Pain Med. 2016;41(2):251–60.

    CrossRef  Google Scholar 

  9. Boon JM, Abrahams PH, Meiring JH, Welch T. Lumbar puncture: anatomical review of a clinical skill. Clin Anat. 2004;17(7):544–53.

    CAS  CrossRef  Google Scholar 

  10. Engelborghs S, et al. Consensus guidelines for lumbar puncture in patient with neurological disease. Elsevier; 2017.

    CrossRef  Google Scholar 

  11. Straus SE, et al. How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis? JAMA. 2006;296:2012–22.

    CAS  CrossRef  Google Scholar 

  12. Mofidi M, et al. Ultrasound guided lumbar puncture in emergency department: time saving and less complications. J Res Med Sci. 2013;18(4):303–7.

    PubMed  PubMed Central  Google Scholar 

  13. Soni NJ, et al. Ultrasound guidance for lumbar puncture. Neurol Clin Pract. 2016;6:358–68.

    CrossRef  Google Scholar 

  14. Nagdev A, et al. How to perform an ultrasound-assisted lumbar puncture. ACEP; 2014.

    Google Scholar 

  15. Pisupati D, Heyming TW, Lewis RJ, Peterson MA. Effect of ultrasonography localization of spinal landmarks on lumbar puncture in the emergency department. Ann Emerg Med. 2004;44:S83.

    CrossRef  Google Scholar 

  16. Nomura JT, Leech SJ, Shenbagamurthi S, et al. A randomized controlled trial of ultrasound-assisted lumbar puncture. J Ultrasound Med. 2007;26:1341–8.

    CrossRef  Google Scholar 

  17. Lee WS, Jeong WJ, Yi HY, Ryu S, Lee JW, Kim SW. The usefulness of ultrasound-assisted lumbar puncture on adult patients in the emergency center: comparison with classic lumbar puncture. J Korean Soc Emerg Med. 2008;19:562.

    Google Scholar 

  18. Cho YC, Koo DH, Oh SK, Jeong WJ, Lee WS, You YH. Comparison of ultrasound-assisted lumbar puncture with lumbar puncture using palpation of landmarks in aged patients in an emergency center. J Korean Soc Emerg Med. 2009;20:304.

    Google Scholar 

  19. Peterson MA, Pisupati D, Heyming TW, Abele JA, Lewis RJ. Ultrasound for routine lumbar puncture. Acad Emerg Med. 2014;21:130–6.

    CrossRef  Google Scholar 

  20. Perlas A. Evidence for the use of ultrasound in neuraxial blocks. Reg Anesth Pain Med. 2010;35:S43–6.

    CrossRef  Google Scholar 

  21. Ferre RM, Sweeney TW. Emergency physicians can easily obtain ultrasound images of anatomical landmarks relevant to lumbar puncture. Am J Emerg Med. 2007;25:291–6.

    CrossRef  Google Scholar 

  22. Darrieutort-Lafte C, Bart G, Planche L, et al. Usefulness of a pre-procedure ultrasound scanning of the lumbar spine before epidural injection in patients with a presumed dif cult puncture: a randomized controlled trial. Joint Bone Spine. 2015;82(5):356–61.

    CrossRef  Google Scholar 

  23. Soni NJ, Franco-Sadud R, Kobaidze K, Schnobrich D, Salame G, Lenchus J, et al. Recommendations on the use of ultrasound guidance for adult lumbar puncture: a position statement of the Society of Hospital Medicine. J Hosp Med. 2019:14(10).

    Google Scholar 

  24. Barsuk JH, Cohen ER, Caprio T, et al. Simulation-based education with mastery learning improves residents’ lumbar puncture skills. Neurology. 2012;79(2):132–7.

    CrossRef  Google Scholar 

  25. Margarido CB, Arzola C, Balki M, Carvalho JC. Anesthesiologists’ learn- ing curves for ultrasound assessment of the lumbar spine. Can J Anaesth. 2010;57(2):120–6.

    CrossRef  Google Scholar 

  26. Terblanche NC, Arzola C, Wills KE, et al. Standardised training program in spinal ultrasound for epidural insertion: protocol driven versus non-proto- col driven teaching approach. Anaesth Intensive Care. 2014;42(4):460–6.

    CAS  CrossRef  Google Scholar 

  27. Pouraghaei M, Tarzamani MK, Moharramzadeh P, Nikniaz S, Karimian S, Balafar M. Ultrasound guided lumbar puncture reduces failed punctures, spent time and number of attempts in emergency department. J Res Clin Med. 2020;8:20.

    CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Camilo N. Rodríguez .

Editor information

Editors and Affiliations

Algorithm

Algorithm

figure a

CSF Cerebral spinal fluid, CT Computed tomography, MRI Magnetic resonance image, ABCD Airway, breath, circulation, disability, US Ultrasound, LMWH Low molecular weight heparin, NOAC New oral antocoagulant

Rights and permissions

Reprints and Permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Rodríguez, C.N., Fong, T. (2022). Point-of-Care Ultrasound: Guidance for Lumbar Puncture. In: , et al. Neurosonology in Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-030-81419-9_58

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-81419-9_58

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-81418-2

  • Online ISBN: 978-3-030-81419-9

  • eBook Packages: MedicineMedicine (R0)