Variability of Infant LP Insertion Site Based On Procedural Experience

Boston Children's Hospital

Status: Completed

Conditions: Traumatic Lumbar Puncture

Treatments: Other: Spinal Sonography

Study type: Interventional

Funder types: Other

Identifiers

NCT02949869

IRB-P00023833

Details and patient eligibility

About

The reported rate of unsuccessful traditional LP in children (defined as the inability to obtain cerebrospinal fluid or obtaining a traumatic puncture) is as high as 50%. Many factors affect LP success including provider experience. CSF is obtained by puncturing the subarachnoid space (traditionally at the L3-L4 or L4-L5 interspinous process space), and many have hypothesized that the width of this space may predict success. Anecdotally, trainees and those with less experience, tend to perform the LP too low (caudally), where the subarachnoid space tapers, or too laterally (off the midline) resulting in higher failure rates. The investigators seek to determine if planned LP insertion sites vary between training and attendings, and if so, could the decreased success be explained by smaller subarachnoid spaces.

Enrollment: 110 patients

Sex: All

Ages: Under 12 months old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

1. Less than or equal to 12 months of age
2. Availability of a study sonographer to perform bedside ultrasound

Exclusion criteria

1. Prior history of LP in preceding 72 hours
2. Known spinal cord abnormality (i.e., tethered cord, spina bifida)
3. Clinically unstable patients (acuity level 1)

Trial design

Primary purpose: Diagnostic

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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110 participants in 1 patient group

Infant Lumbar Punctures

Experimental group

Description:

Infants will all be assigned to received two sets of skin markings and sonography exam to assess lumbar puncture landmarks and anatomy.

Treatment:

Other: Spinal Sonography