The use of ultrasound to identify pertinent landmarks for lumbar puncture

Stiffler, Kirk A.; Jwayyed, Sharhabeel; Wilber, Scott T.; Robinson, Angela

doi:10.1016/j.ajem.2006.07.010

Cited by 100 publications

(55 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Those with difficult to palpate landmarks may be a better population to apply US to. This finding correlates well with the observation of Stiffler et al 18 that US is able to identify landmarks in 75% of obese patients. Unfortunately the small number of patients in this subgroup limits our ability to interpret this difference.…”

Section: Discussionsupporting

confidence: 81%

“…17 In two studies, US was able to identify spinal landmarks important for successful LP in a significant majority of patients, even in the obese population. 18,19 Only one other study we are aware of evaluated the benefits of using US for LP in a randomized controlled trial. 20 When evaluating the emergency department (ED) patient for possible subarachnoid hemorrhage (SAH), cerebral spinal fluid (CSF) analysis is often used to rule out SAH not seen on imaging studies.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Ultrasound for Routine Lumbar Puncture

Peterson

Pisupati

Heyming

et al. 2014

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: The objective was to determine if use of ultrasound (US) by emergency physicians (EPs) to localize spinal landmarks improves the performance of lumbar puncture (LP).Methods: This was a prospective, randomized, controlled study conducted in a county teaching hospital. Subjects, adults 18 years of age or older who were to receive LPs for routine clinical care in the emergency department (ED), were randomized either to undergo US localization of the puncture site or to have the puncture site determined by palpation of spinal landmarks. Primary outcomes were the number of needle insertion attempts and success of the procedure. Secondary outcomes were pain associated with the procedure, time to perform the procedure, number of traumatic taps, and patient satisfaction with the procedure.Results: One-hundred patients were enrolled in the study, with 50 in each study group. There were no significant differences between the two groups in terms of age, sex, body mass index (BMI), indication for LP, or ease of palpation of landmarks. For both primary outcomes and secondary outcomes there were no significant differences between those undergoing US localization and those with palpation alone.

show abstract

Section: Discussionsupporting

confidence: 81%

mentioning

confidence: 99%

Ultrasound for Routine Lumbar Puncture

Peterson

Pisupati

Heyming

et al. 2014

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…1 However, surface landmark identification of underlying structures has been shown to be accurate only 30% of the time and can be difficult in the obese patient. 2 CSF analysis is a valuable diagnostic tool. The American College of Radiology (ACR) Appropriateness Criteria include LP as a recommended procedure in the setting of negative findings on CT head in the clinical scenario of thunderclap headache when subarachnoid hemorrhage is suspected.…”

Section: Abbreviationsmentioning

confidence: 99%

Fluoroscopic-Guided Lumbar Puncture: Fluoroscopic Time and Implications of Body Mass Index--A Baseline Study

Boddu¹,

Corey²,

Saindane³

et al. 2014

American Journal of Neuroradiology

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: Fluoroscopic-guided lumbar puncture is an effective alternative to bedside lumbar puncture in challenging patients. However, no published guidelines are available for an acceptable range of fluoroscopic time for this procedure. The purpose of this study was to set department benchmark fluoroscopic times for lumbar puncture, accounting for body mass index in our patient population.

show abstract

“…5,6 Substantial evidence supports the use of US guidance to perform LPs. In the study mentioned earlier linking BMI with landmark identification, US guidance allowed their identification in all obese patients, 3 and others showed its benefit when performing LPs in different settings. [7][8][9] The added costs of fluoroscopy and US guidance over the standard procedure seem comparable.…”

mentioning

confidence: 99%

“…Our findings are consistent with previous studies suggesting an inverse relationship between BMI and unsuccessful LP. 2 A study conducted by Stiffler et al 3 addressed the relationship between BMI and ability to identify landmarks. Successful identification of landmarks by palpation was successful in all subjects with normal BMI but only in 74% of obese patients.…”

mentioning

confidence: 99%