Lumbar Puncture Needle Research Articles

The learning curve for minimally invasive Achilles repair using the “lumbar puncture needle and oval forceps” technique

IntroductionAn acute Achilles tendon rupture represents a common tendon injury, and its operative methods have been developed over the years. This study aimed to quantify the learning curve for the minimally invasive acute Achilles tendon rupture repair.MethodsFrom May 2020 to June 2022, sixty-seven patient cases who received minimally invasive tendon repair were reviewed. Baseline data and operative details were collected. The cumulative summation (CUSUM) control chart was used for the learning curve analyses. Achilles tendon rupture score (ATRS), American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score, and visual analog scale (VAS) at 3/6/9/12 months were calculated to assess the clinical outcomes.ResultsThirty-six cases underwent at least a year of follow up and were enrolled in this study. The gender ratio and average age were 80.5% and 32.5 years. The linear equation fitted well (R2 = 0.95), and CUSUM for operative time peaked in the 12th case, which was divided into the learning phase (n = 12) and master phase (n = 24). No significant difference was detected between the two groups in clinical variables, except for the operative time (71.1 ± 13.2 min vs 45.8 ± 7.2 min, p = 0.004). Moreover, we detected one case with a suture reaction and treated it properly.ConclusionMinimally invasive Achilles repair provides an opportunity for early rehabilitation. Notably, the learning curve showed that the “lumbar puncture needle and oval forceps” technique was accessible to surgeons.

A controlled lumbar puncture procedure improves the safety of lumbar puncture.

In order to improve the safety of lumbar puncture (LP), we designed a new type of LP needle, that is, an integrated and controlled LP needle, which can actively and accurately control the flow rate and retention of cerebrospinal fluid (CSF) during puncture, so as to achieve a controlled LP procedure. To evaluate whether a controlled LP procedure can improve the comfort of LP and reduce the risk of complications associated with LP. Patients requiring LP (n = 63) were pierced with an integrated and controlled LP needle or a conventional LP needle. The differences in vital signs, symptom score, comfort, operation time, CSF loss, CSF pressure fluctuation and back pain before and after puncture were analyzed. An integrated and controlled LP needle (n = 35) significantly improved patients' headache symptoms before and after puncture. In addition, a controlled LP procedure significantly reduced the amount of unnecessary CSF loss (p < 0.001), shortened the time of puncture (p < 0.001), improved patient comfort (p = 0.001) and reduced the incidence of back pain (p < 0.001). For patients with high intracranial pressure (HICP), the fluctuations in pressure of the CSF were also reduced while obtaining similar amounts of CSF (p = 0.009). A controlled LP procedure avoids unnecessary CSF loss, prevents rapid fluctuations in CSF pressure in patients with HICP, and reduces the risks associated with LP.

Modified nusinersen intrathecal injection method: inclusion of a septal needle-free closed infusion connector.

Nusinersen, an extremely expensive biologic drug (around 100,000 US$ per dose) that needs to be administered intrathecally, is approved for the treatment of 5q-spinal muscular atrophy (SMA). Because of the low muscle tone of the back muscles of pediatric SMA patients, especially type 1 SMA patients, the safe, effective, and fast execution of sheath injection is needed. Therefore, a modified intrathecal injection method was developed accordingly. This paper aims to describe the applicability and safety of this modified method. The modified intrathecal injection method (MIIM) mainly includes a septal needle-free closed infusion connector between the lumbar puncture needle and the syringe, besides the procedures of routine lumbar puncture. Its applicability and safety were evaluated through clinical observation. A total of 92 children with SMA have successfully received nusinersen treatment at our hospital using the modified method since 2019 without obvious adverse events related to the modified injection method. Based on the clinical feedback of operators, the advantages of the modified method include successfully injecting the total dose of nusinersen with constant injection rate and a more stable fixation of the puncture needle, as well as making the operator more relaxed. However, compared with the routine method, the procedure of the modified method has additional steps. The modified intrathecal injection method is an effective and safe method to inject nusinersen when weighing the pros and cons, and it may also be used for administering intrathecal injections of other expensive medicines or for patients with other strict requirements for intrathecal injection.

Practice of Pediatric Spinal Anesthesia in a Country with Limited Means: Example of Togo

Introduction: The practice of spinal anesthesia in pediatric surgery is declining, especially in countries with limited means. What about in our context? Objective: To evaluate the practice of spinal anesthesia in pediatric surgery in Togo. Framework and method of study: This was a prospective study from November 2017 to May 2018 in pediatric surgery at CHU SO de Lomé, in the operating room and hospital ward of CHU Kara. The surgical, anesthesiological and evolutionary aspects of the patients were analyzed. Results: Sixty children were selected for the study who had an indication for sub-umbilical surgery. The male sex was predominant (73.3%). 47 (78.30%) patients were operated on for scheduled surgery. Hernia repair was the most performed surgical intervention (43.30%). The mean duration of the surgery was 78 ± 35.9 minutes. Most of the patients were ASA 1 (98.30%). The local anesthetic used was 0.5% isobaric Bupivacaine. Fentanyl was the predominant adjuvant (55%). The most widely used lumbar puncture needle was 25 Gauge with 75 millimeters in length (63.30%). Diazepam was the most widely used sedative (50%). The predominant spinal anesthesia protocol was spinal anesthesia alone (60%). Only one patient had hypotension (1.70%). Conclusion: The fairly satisfactory pediatric spinal anesthesia in Togo remains poorly performed. Its promotion involves the training of anesthesia practitioners and the strengthening of the technical platform.

Fasudil inhibits hepatic artery spasm by repressing the YAP/ERK/ ETA/ETB signaling pathway via inhibiting ROCK activation.

Objective: To explore the effect of Fasudil on HA spasm and its underlying mechanism.Methods: Rabbits were divided into Sham, Fasudil, and Model groups for experiments. Fasudil was injected into the left medial lobe of the rabbit liver using a 16G lumbar puncture needle through the laparotomic route. The spasm model was established by inserting the catheter sheath into the femoral arteries of rabbits, followed by celiac artery angiography and left HA catheterization with a micro-catheter. Next, the GSE60887 and GSE37924 datasets concerning Fasudil treatment were analyzed. Moreover, immunofluorescence staining was conducted for YAP1 and α-SMA. Finally, Western blotting was performed to examine the expressions of YAP1, ROCK, ERK1/2, ETA, and ETB.Results: Fasudil could relieve HA spasm. The Go and KEGG pathway analyses revealed that the MAPK signaling pathway and the Hippo signaling pathway were enriched in vasospasm. Besides, GSEA revealed that ROCK was functionally enriched in the MAPK and Hippo signaling pathways. Co-expression analysis revealed that MAPK1 was significantly correlated with YAP1 and MYC, and YAP1 was significantly correlated with ETA and ETB. It was manifested in the results of immunofluorescence staining that the YAP1-positive fluorescence area was significantly decreased after Fasudil treatment. Moreover, Western blotting results showed that Fasudil decreased the expressions of YAP1, RhoA, ROCK, ETA, ETB, and p-ERK1/2. In addition, in-vitro Western blotting revealed that Fasudil suppressed the YAP/ERK/ETA/ETB signaling pathway in the case of HA spasm by inhibiting ROCK activation.Conclusions: Fasudil ameliorates HA spasm through suppressing the YAP/ERK/ETA/ETB signaling pathway and the ROCK activation.

To study the incidences of needle stick injury among critical care nurses working in rural tertiary care hospital

Needle-stick injuries (NSIs) are a hazard for nursing staff and public health. Nursing workers are at high risk for occupational exposure to blood-borne pathogens via sharp injuries of the needle-stick. Needle-stick injuries (NSIs) are described as penetrating wounds caused by a device that is contaminated with another person’s body fluids. Needle-stick injuries are injuries acquired by needles like -scalp vein needles, hypodermic needles, blood sample collection needles, intracath stylets, lumbar puncture needles used to connect parts of IV delivery systems. Needle-stick injuries (NSIs) form a medium for the transmission of bloodborne infections. Strict use of personnel protective equipment while working in the hospital should be made compulsory. To study incidences of needle stick injury among nurses working in Rural tertiary care Unit, Loni. Ethical approval for this study was obtained from the Institutional Ethical Committee. Seventy-six nurses, who fulfilled inclusion criteria were included and data was obtained through survey. This study involves 76 nursing staff. Of them all, 27(35.5%) nursing staff experienced NSIsThe administration of medication was common action that caused most of needle-stick injuries mentioned by 14 (18.4%) nursing staff. IV cannula was the device that caused many needle-stick injuries reported by 17 (21.1%) nursing staff. Thenursing professionals are the main key players in both elective and emergency situations. There is a quite higher incidence of needle stick injury among critical care nurses. This might be due to handling of emergency cases and attempting to secure the intravenous line or to deliver the medications. Creating awareness and training appropriately is mandatory for critical care nurses.

170 Did the atraumatic lumbar puncture needle campaign have any effect?

ObjectivesTo assess the impact of a national atraumatic lumbar puncture needle campaign on lumbar puncture needle usage across the United Kingdom. The campaign commenced in 2015, to increase usage of atraumatic needles to reduce complications associated with traumatic needles.DesignRetrospective cross-sectional auditMethodsWe requested procurement orders from all regional neuroscience centres in the United Kingdom, through freedom of information (FOI) requests to identify their lumbar puncture needle purchases over a four-year period (2015–2018). Of all sites, 20 centres provided usable datasets. Product codes were cross correlated to identify the type of lumbar puncture needle used. The procurement orders were used as a surrogate marker for lumbar puncture needle usage and to calculate a ratio of atraumatic: traumatic needles.ResultsIn total we analysed 739,209 procurement orders over the four-year period. The Atraumatic/Traumatic needle ratio was 0.244 ± 0.039 in 2015 and increased to 0.276 ± 0.046 in 2016 (p=0.05), witha subsequent decrease in 2017 to 0.252 ±0.042 (p=0.37) and 2018 to 0.256 ± 0.037 (p=0.93).ConclusionsDespite the increase between 2015 and 2016, the impact of the atraumatic lumbar puncture needle campaign has been marginal. Further efforts will be needed to effect a change in the ‘needle culture’ across neuroscience centres. Aside from the campaigning to highlight reduced complications and the cost-effectiveness of atraumatic needles, further initiatives such as a Delphi process should be considered.gideonadegboyega@gmail.com117

178 Atraumatic lumbar puncture campaign – effect on complications

AimsTo assess the impact of the usage of atraumatic lumbar puncture needles on lumbar puncture complications across the United Kingdom, following the national atraumatic lumbar puncture needle campaign which commenced in 2015DesignA retrospective cross-sectional audit of regional datasets was employed.SubjectsAll patients undergoing a lumbar puncture for both therapeutic and diagnostic purposes at regional neuroscience centres.MethodsWe requested hospital episode statistics (HES) from all regional neuroscience centres in the United Kingdom (32 sites). Through freedom of information (FOI) requests we asked the centres to provide the number of epidural blood patches procedures, post-lumbar puncture headaches and lumbar puncture needle procurement orders over a four-year period (2015–2018). A surrogate complication rate was cal- culated by the sum of the complications divided by the total procurement orders.ResultsOf all sites 32 sites, 16 centres provided usable datasets. Between the period of 2015–2018 there was a non-significant decrease in complication rates when using atraumatic lumbar puncture needles (p=0.14).ConclusionsThe study did not show a statistically significant decrease in the complication rates over the specified period, supported by previous work suggesting poor adherence to atraumatic needle usage.ines-alsousa@hotmail.com

Adverse events/adverse reactions of acupoint catgut embedding therapy for psoriasis vulgaris: a systematic review

To systematically review the occurrence of adverse events/adverse reactions (AEs/ARs) induced by acupoint catgut embedding therapy for psoriasis vulgaris (PV) and its safety. Randomized controlled trials, controlled clinical trials, cohort studies, case-control studies, case-series, and case reports concerning the treatment of PV with acupoint catgut embedding therapy were searched from Chinese and English databases from their inception to January 7th, 2021. The AEs/ARs related to acupoint catgut embedding therapy for PV were subjected to descriptive statistics, followed by the analysis of possible reasons. Finally, 16 studies were included, involving 1 158 patients. A total of 79 cases were reported to present with mild to moderate AEs/ARs related to acupoint catgut embedding therapy for PV, and there were no serious AEs/ARs or death cases. The most common AEs/ARs were local redness, swelling, heat, and pain (31.65%,25/79), followed by low-grade fever and fatigue (29.11%,23/79), isomorphic reaction (16.46%,13/79), local induration (13.92%,11/79), and fainting (8.86%,7/79). In terms of embedding materials, catgut (93.67%,74/79) and lumbar puncture needles or other puncture needles (49.37%,39/79) were proved the most common AEs/ARs-inducing factors. The proportion of AEs/ARs resulting from treatment interval≤two weeks (67.09%,53/79) and treatment course≤eight weeks (55.70%,44/79) was relatively high. Because the incidence of AEs/ARs fails to be calcula-ted, it is not yet possible to accurately assess the risk and safety of acupoint catgut embedding therapy for PV. Available evidence suggests that in the treatment of PV, acupoint catgut embedding therapy may induce a series of mild to moderate AEs/ARs, so its clinical practice deserves attention. We should strictly grasp its indications and contraindications, and prevent the occurrence of related AEs/ARs by standardizing the operation and improving the embedding materials.

Prevalence and Severity of Steatosis in Chronic Hepatitis C patients

Background: Hepatitis C virus infection is a worldwide health issue. The rise in the prevalence of steatosis may be attributed to alterations in eating patterns, changes in the nutritional content of food, and changes in lifestyle, such as decreased physical activity and high sedentary lifestyle, as well as etio-pathogenic variables that influence individuals from infancy. Objective: To determine prevalence and severity of steatosis in chronic hepatitis C patients Methodology: The current study was cross sectional study piloted at the Gastroenterology Department, Hayatabad Medical Complex, Peshawar. The duration of study was six months after synopsis approval from August 2021 to January 2022. Totally 200 patients fulfilling the inclusion criteria were included in our study. Under aseptic conditions, a liver biopsy was done using an 18G lumbar puncture needle. All the Data analysis was done by using IBM SPSS version 24. Results: The overall frequency of steatosis was 80 (40%). On the basis of degree of steatosis, mild steatosis was observed in 53 (58.89%) subjects, moderate steatosis in 31 (34.44%) patients while severe steatosis was observed in 6 (6.67%) subjects. Conclusion: Our study concludes that steatosis is a common histological characteristic in patients with chronic hepatitis C virus infection. Steatosis is more prevalent in female patients than males. Study based on large sample size is recommended to get better findings. Keywords: Prevalence; Severity; Steatosis; Hepatitis C

Acute Bacterial Meningitis

Acute bacterial meningitis is a life-threatening infection. By definition, meningitis is an infection of the meninges and the subarachnoid space. Bacterial meningitis is associated with an inflammatory response that involves the meninges, the subarachnoid space, the brain parenchyma, and the cerebral arteries and veins. As such, bacterial meningoencephalitis is the more accurate descriptive term. This chapter discusses the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of the disease. The discussion of diagnosis covers clinical manifestations, physical examination findings, laboratory tests, and imaging studies. The discussion of treatment covers empirical therapy, specific antimicrobial therapy, and dexamethasone therapy. Graphs compare causative organisms and clinical manifestations of community-acquired meningitis. Illustrations depict proper patient positioning for detecting nuchal rigidity, Kernig sign, Brudzinski sign, and lumbar puncture, as well as a sagittal view of a lumbar puncture needle as it is advanced into the subarachnoid space. An algorithm delineates the approach to the patient with symptoms and signs of bacterial meningitis. Tables outline bacterial pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, the appearance of the organism on a Gram stain, empirical antimicrobial therapy based on predisposing and associated conditions, recommendations for specific antibiotic therapy in bacterial meningitis, and recommended doses for antibiotics commonly used in the treatment of bacterial meningitis. This chapter contains 8 figures, 13 tables, 78 references Keywords: Bacterial meningitis, antibiotics, Kernig sign, Brudzinski sign, nuchal rigidity, headache

Successful subarachnoid block following a dry tap in a geriatric patient

Rationale: Dry tap' is the absence of cerebrospinal fluid (CSF) despite lumbar puncture needle placement in the thecal sac. Patient Concern: it is a troublesome condition and poses significant challenges. Diagnosis: An experienced anaesthesiologist develops the ability to recognise the needle advancing through the ligaments culminating in a subtle 'pop' or 'give way' to ultimately reach the subarachnoid space, and the needle position is confirmed by a free flow of clear CSF. Intervention: subarachnoid block. Outcomes: successful subarachnoid block following a dry tap in a geriatric patient. Lessons: Spinal anaesthesia can be successful despite a dry tap in experienced hands and may be attempted before resorting to alternative techniques.

Platelet Transfusions Prior to Lumbar Punctures, What Is the Evidence?

Introduction:Lumbar punctures (LPs) are routinely used to administer intrathecal chemotherapy for children and adults with hematologic malignancies. The platelet threshold at which an LP can be safely performed is a debated topic. A platelet count of ≥50x10 9/L is a widely accepted threshold despite sparse evidence supporting this number (Kaufman et al 2003). Previous studies failed to report any increase in the incidence of post-procedure adverse events in patients with a platelet count below this threshold who undergo LPs (Corroa et al 2018, Chung et al 2020, Öztürk et al 2021). However, these prior studies were limited in their sample size for the number of LPs done in patients with platelets <50 x 10 9/L.Objectives:To assess the effects of differing platelet transfusion thresholds (<50 x 10 9/L versus ≥50x10 9/L) in patients undergoing lumbar punctures.Methods:We performed a computerized search of Medline, Cochrane and Google Scholar databases through January 2021 for studies evaluating lumbar punctures in adult and pediatric patients. We searched for randomized control trials, non-randomized controlled trials, cohort studies, and retrospective case series. We included any study that involved transfusions of platelet concentrates and was given to prevent bleeding in people of any age with thrombocytopenia that required insertion of a lumbar puncture needle or epidural catheter. We screened 10502 studies and 17 of the studies met criteria for review and were included in the final review. Standard methodological review was completed for each study. Two review authors independently assessed studies for eligibility and extracted data. Results are expressed narratively, and a meta-analysis was performed evaluating traumatic taps with a platelet threshold of <50 x10 9/Lcompared to those over the transfusion threshold of ≥50x10 9/L.Results:We identified 7 retrospective cohort studies and 10 case series that contained patients who received and did not receive any platelets prior to lumbar puncture procedures (Table 1). Most of the studies (12/17) had a patient population that included an oncologic diagnosis with hematologic malignancies being the most common (Table 1). We summarized the studies in narrative form with relevant outcomes (Table 1).Spinal hematoma as an outcome was documented in 12/17 studies. There was no difference in spinal hematomas in patients with platelet counts of <50 x10 9/Lcompared to those over the transfusion threshold of ≥50x10 9/L (Table 1).We performed a meta-analysis in patients with platelet counts of <50 x10 9/Lcompared to those over the transfusion threshold of ≥50x10 9/L for the outcome of traumatic taps. When traumatic taps were defined as greater than 10 x 10 6 RBCs/L, the incidence of traumatic taps favored the patients who had a platelet count ≥50x10 9/L (Figure 1). However, when traumatic taps were defined as >400 RBCs/L the incidence of traumatic taps favored the patients who had a platelet count <50 x10 9/L (Figure 1).There were no studies that evaluated all-cause mortality within 30 days of the procedure, length of stay, and quality of life outcomes in patients.Conclusion:We found no clinical trials to base our recommendations on platelet thresholds prior to a lumbar puncture. We did find multiple studies that should have enough patients to determine if a platelet threshold less than <50 x10 9/L is associated with increased spinal hematomas. There was no increase in spinal hematomas when the platelet count <50 x10 9/L was compared to a cohort with a platelet count ≥50x10 9/L.The meta-analysis of traumatic taps depended on the definition of traumatic taps and when traumatic taps were defined as greater than 10 x 10 6 RBCs/L, the incidence of traumatic taps favored the patients who had a platelet count ≥50x10 9/L. Whereas, when traumatic taps were defined as >400 RBCs/L the incidence of traumatic taps favored the patients who had a platelet count <50 x10 9/L.A multicenter prospective study is needed to clarify the incidence of traumatic taps and to verify the data regarding spinal hematomas, other adverse events or quality of life measures in patients. [Display omitted] DisclosuresLaber: Alexion: Membership on an entity's Board of Directors or advisory committees. Visweshwar: Biogen Idec: Membership on an entity's Board of Directors or advisory committees. Jaglal: Novartis: Membership on an entity's Board of Directors or advisory committees; Sanofi: Membership on an entity's Board of Directors or advisory committees.

Bone Marrow Aspiration Using 18g Lumbar Puncture Needle

INTRODUCTION: Bone marrow aspiration (BMA) has an important role in the investigation and diagnosis of hematologic as well as nonhematologic malignancies and various other diseases. The procedure varies from one setting and person to the other. AIMS: The aim of the study is to study the role of 18G lumbar puncture (LP) needle in the diagnosis of bone marrow involvement in hematologic malignancies and metastasis for certain solid tumors. MATERIALS AND METHODS: During this hospital-based retrospective study, 708 patients who clinically and histopathologically diagnosed with the malignant lesion and subsequently undergone BMA were included in this study. RESULTS: BMA was done in 607 patients diagnosed with hematologic malignancies and 101 patients diagnosed with nonhematologic malignancies. Adequate marrow material was obtained in the first attempt in 683 (96.5%) cases. Multiple aspirations were needed in 25 (3.5%) cases. The majority (86.3%) of the patients experienced less pain by the 18 G LP needle compared to their previous experience with the conventional BMA needle. Needle breakage was not seen in any of the cases. CONCLUSION: The results of this study suggest that the 18G LP needle can be easily adopted for BMA and could be a great help in significantly reducing pain and complications in patients undergoing BMA.

Clincal observation of non-absorbable suture cerclage combined with patella claw fixation for treatment of inferior patella fractures

To investigate the effectiveness of non-absorbable suture cerclage combined with patella claw fixation for the treatment of inferior patella fractures. Between September 2016 and January 2019, 22 patients with inferior patella fractures were treated. There were 12 males and 10 females, with a mean age of 49.1 years (range, 32-67 years). The causes of injury were traffic accident in 8 cases, falling in 12 cases, and other causes in 2 cases. The interval from injury to operation was 3-7 days (mean, 4.4 days). For the operation, 3 or 4 longitudinal tunnels were drilled backward from the surface of the proximal fracture fragment with Kirschner wires; under the guidance of lumbar puncture needles and steel wires, non-absorbable suture passed through the tunnels and encircled the inferior fracture fragment, then tighten to achieve a satisfactory reduction of the fracture; finally, the patella claw was used to strengthen the fixation. During the follow-up, complications were observed, maximum motion range of the knee joint was measured, X-ray examination was performed and fracture healing time was recorded. The knee function was evaluated according to Böstman scores. All the 22 patients were followed up 12-36 months (mean, 19.4 months). No infection, joint stiffness, bone nonunion, loss of reduction, or displacement of internal fixation occurred. All fractures were clinically healed, and the bone healing time was 2-3 months (mean, 2.6 months). At last follow-up, the maxium motion range of knee joint was 130°-135°, with an average of 132.6°. The Böstman score of the affected knee was 28-30 (mean, 29.2). All cases were graded as excellent results. Non-absorbable suture cerclage combined with patella claw fixation for inferior patella fractures has the advantages of simple operation, reliable fixation, and few complications, and the clinical results are satisfactory.

Influence of procedural factors on patient procedural pain in relation to diagnostic lumbar puncture.

The aim of this study is to investigate the influence of local anesthetic (LA), operator experience level and needle type on patient procedural pain in relation to diagnostic lumbar puncture (LP). LP was performed with either a 22 gauge traumatic needle (22 TN) or a 22 gauge atraumatic needle (22 ATN). Immediately after LP patients documented a procedural pain score (PPS) on a 10-point Likert scale. Use of LA, needle type, anesthetic time interval (ATI), number of needle insertions and the LP operator experience level were registered. ATI was defined as the time from administration of LA to first needle insertion. 104 patients had the LP procedure performed by 66 physicians (40 novices and 26 experienced physicians). Patients having the procedure performed by novices had a lower PPS of 2.56 if LA was administered compared to a higher PPS of 5.80 if LA was not administered (P = .046). Among experienced physicians there was no difference in PPS regardless of administration of LA. If novices administered LA, patient PPS was equal to patients having the procedure performed by an experienced operator. If novices performed the procedure with a 22 TN PPS decreased with increasing ATI (P = .01). No similar correlation was identified with the 22 ATN. Our study suggests that LP operator experience level, the needle type used and ATI may influence patient PPS. Further studies are necessary for final conclusions. These studies must consider these factors to avoid fault conclusions.

Introducing a Robotic Lumbar Puncture Simulator with Force Feedback: LP Simd

Purpose: Lumbar Puncture (LP) is widely used for spinal and epidural anesthesia or Cerebrospinal fluid (CSF) sampling procedures. As this procedure is highly complicated and needs high experience to be performed correctly, it is necessary to teach this skill to the physicians. Considering the limitation of number of usage of rubber models and advantages of Virtual Reality (VR) environment for digital training of skills, we tried to investigate the capability of VR environment to train the LP procedures.with TLE. Materials and Methods: Geometrical model of the lumbar area of L2 to L5 are extracted from fusion of MR and CT imaging modalities. Also physical model of resistance of each layers against needle insertion at lumbar area are investigated through specially designed sensorized handle for LP needle and recorded from a 41-yearold female patient. Then geometrical and physical models of lumbar area are fused together and the Virtual Reality (VR) model of it, with insertion force rendering capability is extracted. Then the model is integrated with a haptic device and the complete VR environment is investigated. Results: In this work we introduced a robotic Lumbar Puncture Simulator (LP Sim) with force feedback which may be used for training the LP procedures .Using LP Sim, when the trainee insert the needle inside the lumbar area at the provided virtual reality environment, he/she may feel the insertion forces against his/her movement inside the lumbar area. Conclusion: The LP Sim is a virtual reality-enabled environment, with force feedback, that provides an appropriate framework for training this skill.

Converting to Atraumatic Lumbar Puncture Needles; Experience from the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK (4095)

Converting to Atraumatic Lumbar Puncture Needles; Experience from the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK (4095)

Indication to use a non-pencil-point lumbar puncture needle

In their article in the BMJ , Rochwerg and colleagues recommend using an atraumatic pencil-point lumbar puncture (LP) needle.1 We would point out one potential exception to this recommendation: idiopathic...

Clinical practice guideline on atraumatic (pencil-point) vs conventional needles for lumbar puncture: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.

The Scandinavian Society of Anaesthesiology and Intensive Care Medicine Clinical Practice Committee endorses the BMJ Rapid Recommendation clinical practice guideline on atraumatic (pencil-point) vs conventional needles for lumbar puncture. This includes the strong recommendation for the use of atraumatic needles for lumbar puncture in all patients regardless of age or indication.