Ultrasound Assisted Lumbar Puncture: The Not-‐So-‐Steep Learning Curve
Weerasinghe C , Sharma A , Tung P , Weerasinghe A 1
1. Neurology Speciality Registrar Leeds Teaching Hospitals NHS Trust 2. Consultant Anaesthetist Mid Yorkshire NHS Trust 3. Consultant Emergency Physician Mid Yorkshire NHS Trust Correspondence address: email@example.com
IntroducDon • Lumbar puncture (LP) is frequently undertaken in neurology and acute medical se:ngs. • It can take several a>empts causing pa?ent discomfort and anxiety. • The use of ultrasound can reduce the number of failed or trauma?c LPs1.
• To ascertain whether ultrasound assisted LPs can be taught in a controlled environment through a focussed short training programme.
• The course comprised of 80 minutes of lectures and 160 minutes of supervised scanning on training phantoms and live models. • Delegates prac?cal skills were assessed using Kirk-‐Patrick learning and training model2
AC Ultrasound image of lumbar spine in longitudinal (LS) view
Ultrasound image of lumbar spine in transverse (TS) view
• The Sonography Assisted Lumbar puncture Training (SALT) course was created and conducted at Mid Yorkshire Hospitals NHS Trust. • A pre course ques?onnaire assessed previous training in ultrasound and LPs.
L PC SC
AP=ArDcular process; L=Lamina; SC= Spinal Canal; AC=Anterior Complex; PC=Posterior Complex; IS=Interspinous ligament
83.87% Correct idenDﬁcaDon of sonoantomy on LS view in volunteer
Correct idenDﬁcaDon of sonoantomy on TS view in volunteer
• 31 delegates undertook this course.
• 11 were Neurology Trainees and Consultants (35.48%).
Correct idenDﬁcaDon of intervertebral space in volunteer
All delegates ﬁlled the pre course ques?onnaire: • 80.64% (n=25) had performed more than 20 LPs • 70.9% (n=22) had previous ultrasound experience • 38.7% (n=12) had formal ultrasound training. • None had previous experience in ultrasound assisted LPs. The end of course assessment revealed (Figure 1 & 2): • 87.09% (n=27) were able to stabilize the probe and op?mize the ultrasound image on live models independently. • 93.54% (n=29) were able to iden?fy the relevant sonoanatomy independently. • The remaining candidates demonstrated these skills with minimal promp?ng.
0.00% Achieved with prompt
Figure 1: Ultrasound Image AcquisiDon 120.00%
Correct depth measurement from CSF space to skin
Correct marking of midline
• This is the ﬁrst ever Sonography Assisted LP Training course in the UK aimed at Neurologists and Medical Physicians.
• This study shows that ultrasound assisted LPs can be taught in a controlled environment through a focussed short training programme.
0.00% Achieved with prompt
Figure 2: Ultrasound Procedural Skills References 1. Shaikh F, Brzezinski j, Alexander S et al; Ultrasound imaging for lumbar punctures and epidural catheterisa?ons systema?c review and met analysis; BMJ (Mar 2013) 26;346:f1720. doi: 10.1136/bmj.f172 2. Kirkpatrick D. Evalua?ng Training Programs. San Francisco: Berre>-‐Koehler Publishers; 1994