Recommendations on the Use of Ultrasound Guidance for Adult Lumbar Puncture: A Position Statement of the Society of Hospital Medicine

• DOI: 10.12788/jhm.3197
• Publication Date: 2019-06-28T16:08:06Z
• Authors: Nilam J Soni; Ricardo Franco‐Sadud; Ketino Kobaidze; Daniel Schnobrich; Gerard Salame; Joshua Lenchus; Venkat Kalidindi; Michael J Mader; Elizabeth K Haro; Ria Dancel; Joel Cho; Loretta Grikis; the SHM Point‐of‐...
• Keywords: Position statement; Hospital medicine; Position (finance); Statement (logic)

When ultrasound equipment is available, along with providers who are appropriately trained to use it, we recommend that guidance should be used for site selection of lumbar puncture reduce the number needle insertion attempts and redirections increase overall procedure success rates, especially in patients obese or have difficult-to-palpate landmarks. We more accurately identify spine level than physical examination both nonobese patients. suggest using selecting marking a just before performing either lateral decubitus sitting position. The patient remain same position after site. low-frequency transducer, preferably curvilinear array evaluate mark A high-frequency linear transducer may map spine, starting at sacrum sliding cephalad, sequentially identifying interspaces. transverse plane midline longitudinal interspinous spaces. intersection these two lines marks during preprocedural evaluation measure distance from skin surface ligamentum flavum paramedian view estimate depth ensure spinal adequate length used. novices undergo simulation-based training, where attempting ultrasound-guided on actual training adapted based prior experience, as learning curves will vary. novice supervised when independently