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Evaluating Infant Positioning for Lumbar Puncture Using Sonographic Measurements.
- Source :
- Academic Emergency Medicine; Feb2011, Vol. 18 Issue 2, p215-218, 4p, 1 Black and White Photograph, 1 Chart
- Publication Year :
- 2011
-
Abstract
- Objectives: Hypoxia has been observed when infants undergo lumbar puncture in a tight flexed lateral recumbent position. This study used sonographic measurements of lumbar interspinous spaces to investigate the anatomic necessity and advantage derived from this tight flexed positioning in infants. Methods: This was a brief, prospective, observational study of a convenience sample of patients. Twenty-one healthy infants under 1 month of age were scanned in two positions: prone in a spine- neutral position and lateral recumbent with their knees bent into their chest and their neck flexed. In each position, a 5- to 10-MHz linear array transducer was used to scan midline along the lumbar spinous processes in the sagittal plane. The distances between the spinous processes were measured near the ligamentum flavum using the ultrasound machine's calipers. Pulse oximetry was monitored on all infants during flexed positioning. Results: In the spine-neutral position, all studied interspinous spaces were much wider than a 22-gauge spinal needle (diameter 0.072 cm). The mean (±SD) interspinous spaces for L3-4, L4-5, and L5-S1 in a spine-neutral position were 0.42 (±0.07), 0.37 (±0.06), and 0.36 (±0.11) cm, respectively. Flexing the infants increased the mean lumbar interspinous spaces at L3-4, L4-5, and L5-S1 by 31, 51, and 44%, respectively. Conclusions: This study verified that tight, lateral flexed positioning substantially enhances the space between the lumbar spinous processes and that a spine-neutral position also allows for a large enough anatomic interspinous space to perform lumbar puncture. However, further clinical research is required to establish the feasibility of lumbar puncture in a spine-neutral position. [ABSTRACT FROM AUTHOR]
- Subjects :
- ACTIVE oxygen in the body
ANALYSIS of variance
COMPARATIVE studies
COMPUTER software
CONFIDENCE intervals
OUTPATIENT services in hospitals
RANGE of motion of joints
LONGITUDINAL method
LYING down position
HEALTH outcome assessment
OXIMETRY
PATIENT positioning
PEDIATRICS
PROBABILITY theory
STATISTICAL sampling
SPINE
LUMBAR puncture
STATISTICAL hypothesis testing
T-test (Statistics)
PULSE oximeters
STATISTICAL power analysis
DATA analysis
CHILDREN
Subjects
Details
- Language :
- English
- ISSN :
- 10696563
- Volume :
- 18
- Issue :
- 2
- Database :
- Complementary Index
- Journal :
- Academic Emergency Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 58057703
- Full Text :
- https://doi.org/10.1111/j.1553-2712.2010.00977.x