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Ultrasound Assisted  Lumbar  Puncture:  The  Not-­‐So-­‐Steep  Learning  Curve

Weerasinghe  C ,  Sharma  A ,  Tung  P ,  Weerasinghe  A   1

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3

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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: chisha_wickrema@yahoo.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.    

IS

AC

•  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  

SC

ObjecDve

Method  

L

AP

PC

AP=ArDcular process;  L=Lamina;  SC=  Spinal  Canal;  AC=Anterior  Complex;  PC=Posterior  Complex;   IS=Interspinous  ligament    

100.00%

93.54%

90.00%

96.77%

83.87% Correct  idenDficaDon  of   sonoantomy  on  LS  view  in   volunteer  

80.00% 70.00%  

Correct idenDficaDon  of   sonoantomy  on  TS  view  in   volunteer  

60.00% 50.00%  

Results  

40.00%

•  31  delegates  undertook  this  course.  

30.00%

•  11  were  Neurology  Trainees  and  Consultants  (35.48%).      

20.00%

Correct idenDficaDon  of   intervertebral  space  in  volunteer  

12.90%

10.00%

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.  

6.45%

3.22%

3.22%

0.00% Achieved  with  prompt  

Achieved Independently  

Not Recorded  

Figure 1:  Ultrasound  Image  AcquisiDon   120.00%  

100.00%

100.00% 93.54%  

80.00%

Correct depth  measurement   from  CSF  space  to  skin  

60.00%

Conclusion

Correct marking  of  midline  

40.00%

•  This is  the  first  ever  Sonography  Assisted  LP  Training  course  in  the  UK   aimed    at  Neurologists  and  Medical  Physicians.  

20.00% 6.45%  

•  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    

Achieved Independently    

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  

Ultrasound assisted lumbar puncture: the not-­so-­steep learning curve  
Ultrasound assisted lumbar puncture: the not-­so-­steep learning curve  
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