Ultrasound Guidance Importance: Lumbar Puncture
Ultrasound guidance provides clinical information for Lumber Puncture LP site selection that is not obtainable by physical examination. Ultrasound allows measurement of the distance from the skin to ligamentum flavum, allowing for selection of an appropriate length spinal needle and anticipation of the depth of needle insertion before obtaining CSF.
Ultrasound mapping also reveals anatomical information that is not obtainable by physical examination, including width of the interspinous spaces, and spinal bone abnormalities, including scoliosis.
Using static or real time ultrasound, the lumbar spine anatomy is visualized in transverse and longitudinal planes and the needle insertion site is marked. Using real-time ultrasound guidance, the needle tip is tracked in a paramedian plane as it traverses toward the ligamentum flavum.
Which ultrasound scanner is suitable for Lumber Punctures?
A high-frequency, SIFULTRAS-5.31 linear-array transducer generates high-resolution images, and is preferred in lean patients and for training novice providers. However, a low-frequency, SIFULTRAS-5.21 curvilinear transducer is more often used because it provides deeper penetration to visualize the spinal structures in overweight and obese patients.
When ultrasound guidance is available, along with providers who are appropriately trained to use it, Ultrasound guidance should be used for site selection of LPs to reduce the number of needle insertion attempts and needle redirections and increase the overall procedure success rates, especially in patients who are obese or have difficult-to-palpate landmarks.
Ultrasound guidance for LP improves success rates, decreases needle redirections and traumatic taps, and can decrease total procedure time. When static ultrasound guidance is used, visualization of the spinous processes is the key element to mark the needle insertion site. When real-time ultrasound guidance is used, the needle is inserted under direct visualization using a paramedian approach.
References: Recommendations on the Use of Ultrasound Guidance for Adult Lumbar Puncture: A Position Statement of the Society of Hospital Medicine, Ultrasound guidance for lumbar puncture.
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Disclaimer: Although the information we provide is used by different doctors and medical staff to perform their procedures and clinical applications, the information contained in this article is for consideration only. SIFSOF is not responsible neither for the misuse of the device nor for the wrong or random generalizability of the device in all clinical applications or procedures mentioned in our articles. Users must have the proper training and skills to perform the procedure with each ultrasound scanner device.
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