Work

Increased lumbar puncture success using a paramedian approach: A retrospective cohort study

Year: 2025

Type: article

Abstract: BACKGROUND: Lumbar puncture (LP) is frequently necessary in hospitalized patients for diagnostic and therapeutic purposes. Traditional landmark identification by palpation of the lumbar spine and pelvis can see significant failure rates. A paramedian approach is an accepted, though less frequently used technique associated with higher success rates for spinal access in anesthesia when aided by ultrasound. Similarly, point-of-care ultrasound (POCUS) of the paramedian acoustic window may help guide a paramedian LP technique. OBJECTIVE: To compare the probability of success before and after the implementation of a standardized training curriculum for lumbar punctures (LPs) performed by the Hospital Medicine Procedure Service (HMPS). METHODS: The HMPS at the University of Minnesota Medical Center (UMMC), a large tertiary academic medical center, implemented a standardized training for an ultrasound-assisted paramedian (USPM) approach to all bedside lumbar punctures (LPs) and then conducted a retrospective review comparing success rates between the traditional midline (ML) and USPM approaches. RESULTS: A total of 269 LPs were performed on hospitalized patients. Before standardization, the probability of a successful LP was 72.6% using ML approach. After standardization, using a USPM approach, the probability of a successful LP was 85.4%. The probability of a successful procedure was 13.6 (95% confidence interval: 2.8, 24.4, p = .014) percentage points higher for the USPM approach when compared to the ML approach and accounting for sex, age, BMI, and if the LP was for chemotherapy. CONCLUSIONS: Institutions with a HMPS should consider transitioning to use of the USPM approach for bedside LPs, which is associated with a higher probability of success and reduced utilization of more resource-intensive hospital services, such as Interventional Radiology or Neuroradiology.

Source: Journal of Hospital Medicine

DOI: 10.1002/jhm.70138