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    Does obesity preclude lumbar puncture with a standard spinal needle? The use of computed tomography to measure the skin to lumbar subarachnoid space distance in the general hospital population.

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    Authors
    Halpenny, Darragh
    O'Sullivan, Katie E
    Burke, John P
    Torreggiani, William C
    Affiliation
    Department of Radiology, Adelaide and Meath Hospitals incorporating the National Children's Hospital, Tallaght, Dublin, Ireland.
    Issue Date
    2013-06-05
    
    Metadata
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    Citation
    Does obesity preclude lumbar puncture with a standard spinal needle? The use of computed tomography to measure the skin to lumbar subarachnoid space distance in the general hospital population. 2013: Eur Radiol
    Journal
    European radiology
    URI
    http://hdl.handle.net/10147/296777
    DOI
    10.1007/s00330-013-2909-8
    PubMed ID
    23736376
    Abstract
    OBJECTIVES: Failed lumbar puncture (LP) is a common indication for referral for radiologically guided LP. This study aims to evaluate what percentage of the hospital population would fail an LP using a standard 9-cm needle because of obesity and a skin to subarachnoid space distance greater than 9 cm. METHODS: Images of 402 consecutive patients undergoing computed tomography of the abdomen and pelvis were reviewed. Skin to subarachnoid space distance was calculated using sagittal images. A survey was conducted among junior hospital doctors to assess their experience of performing lumbar puncture in obese patients. RESULTS: Four hundred patients were included. Fifty-five patients (13.8 %) had a skin to subarachnoid space distance greater than 9 cm. Intra-abdominal fat, subcutaneous fat and abdominal girth correlated with distance between the skin and subarachnoid space. Among junior doctors, 68.3 % (n = 41) reported LP failure on an obese patient; 78.4 % (n = 47) were unaware of the existence of a longer needle and 13.3 % (n = 8) had experience using a longer needle. CONCLUSIONS: A significant proportion of the hospital population will fail LP with a standard length spinal needle. Selecting a longer needle may be sufficient to successfully complete LP in obese patients. KEY POINTS : • Lumbar puncture failure commonly leads to referral for an image-guided procedure • Standard lumbar puncture may fail in 13.8 % of patients due to obesity • 78.4 % of trainee doctors are unaware of the existence of longer spinal-needles • Using longer spinal needles may allow successful LP in obese patients.
    Item Type
    Article
    Language
    en
    ISSN
    1432-1084
    ae974a485f413a2113503eed53cd6c53
    10.1007/s00330-013-2909-8
    Scopus Count
    Collections
    Tallaght University Hospital

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