Background: The American Board of Internal Medicine suggests residents participate in a minimum of five abdominal paracentesis (AP), central venous catheter (CVC) placements, and lumbar punctures to ensure “adequate knowledge and understanding” of procedures performed by practicing internists. Competency in these procedures is poorly defined and difficult to assess. To address the need for well-supervised, [...]

Background: Lumbar puncture (LP) is commonly needed in hospitalized patients for both diagnostic and therapeutic purposes. Traditional landmark identification by palpation of the lumbar spine and pelvis often has a low success rate. There is strong evidence showing that the use of ultrasound leads to higher success rates, along with other important patient-centered outcomes such [...]

Background: Medicine procedure services (MPS) increasingly perform bedside procedures such as lumbar puncture (LP). While rates of major complications are low, success rates in the literature are widely variable and dependent on patient body habitus, patient positioning, operator experience, and use of ultrasound guidance.1 Many trainees report discomfort with their skill in performing and supervising [...]

Background: Lumbar Punctures (LPs) are generally considered to be safe bedside procedures, but when bleeding complications arise they can be catastrophic with epidural hematomas risking spinal cord compression and paralysis if untreated. Our institution serves a large number of patients with hematologic malignancies requiring intrathecal chemotherapy, sometimes as frequently as twice weekly, who often have [...]

Background: The clinical evaluation of febrile infants less than 28 days has been extensively studied with the aim to improve the sensitivity in identifying those infants at risk for invasive bacterial infections while decreasing the harm of unnecessary invasive diagnostic procedures. Even though bacterial meningitis is associated with high morbidity and mortality, the incidence is [...]

Background: The Lumbar puncture (LP) success rate for graduating pediatric residents is around 54%, and residents often feel uncomfortable performing Lumbar punctures(LPs). An UALP(ultrasound-assisted lumbar Puncture) uses POCUS (point of care ultrasound) to visualize key anatomical landmarks for optimal and safe cerebral spinal fluid (CSF) collection. Evidence has shown improved LP success rates in pediatric [...]

Background: While many physicians graduate from residency with competency to perform bedside procedures such as lumbar punctures (LPs) and paracentesis, the skillset often wanes after years in practice. Though a dedicated procedure service with full-time equivalent support may be a solution in settings where hospitalists need to perform numerous procedures per day, at our large [...]

Background: Lumbar punctures (LPs) are common among hospitalized patients and many institutions have implemented a hospital medicine procedure services (HMPS) to perform these routine bedside procedures. Most clinicians learn to perform this procedure using the midline (ML), landmark-guided approach which involves palpation of the lumbar spine but this technique is associated with failure rates as [...]

Case Presentation: This case report outlines the case of a 76 year-old male who presented with bacterial meningitis secondary to an infected intrathecal baclofen pump, but initial lumbar puncture cerebrospinal fluid (CSF) did not demonstrate pleocytosis. Patient endorsed worsening headache, vomiting, and bilateral lower extremity weakness 6 days prior to admission. He was immediately started [...]

Case Presentation: A 77 year-old female without significant history presented with six months of urinary incontinence, six weeks of progressive confusion and falls, and one day of decreased speech and poor appetite. During two recent hospitalizations for acute encephalopathy, imaging revealed a frontal lobe meningioma, acoustic neuroma, and diffuse ventricular enlargement.On admission, the patient was [...]