Ultrasound imaging aids the learning of the landmark technique for lumbar puncture in novice learners in a secure training environment

Abstract

Background: Performing a lumbar puncture (LP) is a key skill to master for doctors in the emergency department (ED), but the level of success and rate of complications still differs considerably. Studies have shown that LP is attempted at a different level than intended in 30% of cases when the classical landmark technique is used. Ultrasound-assisted LP can reduce the risk of failed LP, possible by its ability to visualize the relevant anatomy of the spine, but only a few studies have considered its potential in learning environments with novice learners. Methods: Medical students and first-year trainee doctors who had never performed a LP in a clinical setting were asked to locate and mark the exact location of where to insert the needle when performing a LP by first using the classical landmark technique secondly by use of ultrasound. Corrections of the marked locations were registered for each attempt. Each participant marked three different healthy volunteers in both sitting and laying positions. Results: The accuracy in LP by landmarking as a total of correct markings (“unchanged”) vs. a total of incorrect markings (“changed”) improved significantly in both the sitting (p = 0.028) and lying positions (p=0.002). All participants were positive about the use of ultrasound when learning how to identify the correct LP marking, mostly because of improved understanding of the anatomical structures and improved confidence in the succeeding attempts. Conclusion: Ultrasound can assist and potentially increase the learning of landmark techniques in novice learners in a secure training environment. Visualizing the underlying anatomical structures of the landmark technique in this way can add a second level of security for the learner for the future practice of LP.