Yıl 2021, Cilt 14 , Sayı 1, Sayfalar 131 - 140 2021-01-04

Acil servise başvuran yetişkin hastalarda lomber ponksiyon yerinin yatak başı ultrasonografi ve palpasyon ile karşılaştırılması
Comparison of lumbar puncture location with bedside ultrasonography and palpation in adult patients admitted to the emergency room

Ömer ÇANACIK [1] , Atakan YILMAZ [2] , Ramazan SABIRLI [3] , Mert ÖZEN [4] , Murat SEYİT [5] , İ̇brahim TÜRKÇÜER [6] , Bülent ERDUR [7] , Ahmet SAROHAN [8] , Hande ŞENOL [9]


Amaç: Lomber ponksiyon (LP) biyokimyasal, mikrobiyolojik ve sitolojik inceleme için beyin omurilik sıvısı örneğinin alındığı tıbbi bir işlemdir. Çalışmamızda, LP'nin yerini belirlemede ultrasonografi (USG) yöntemiyle palpasyon yöntemini karşılaştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya 203 hasta dahil edildi. Çalışmada, Ultrasonografi (USG) sertifikası olan 4. yılını tamamlayan aynı acil tıp asistanı tarafından manuel veya USG ile yer belirtilmesi yapıldı. Katılan hastalarda lomber ponksiyon yeri önce USG, sonra manuel yöntem ile belirlendi ve işaretlendi. Bulgular: USG yönteminin LP yerleşimini belirlemede manuel yöntemden anlamlı derecede daha başarılı olduğu bulundu (p=0.012). LP bölgesinin belirlenmesinde, USG yöntemi özellikle oturma pozisyonunda, manuel yönteme göre anlamlı olarak daha başarılı olduğu bulunmuştur (p=0.031). Diğer pozisyonlarda iki grup arasında fark gözlenmedi (Sağ p=1, Sol p=0.500). Vücut Kitle İndeksi (VKİ) USG ile alanın yer tayini sırasındaki başarıyı etkiledi (p=0.0001). Benzer şekilde, vücut kitle indeksi, LP bölgesini manuel yöntemle tanımlamadaki başarıyı etkilemiştir (p=0.0001). BMI>25 olan hastalarda LP alanının belirlenmesinde USG yönteminin manuel yöntemden anlamlı derecede daha başarılı olduğu bulundu (p=0.012). Sonuç: Palpasyon veya USG ile LP yer tayininde, vücut kitle indeksi arttıkça, yer bulma süresi önemli ölçüde artmıştır. LP yeri palpasyon ile belirlenemeyen hastalarda USG tarafından tanımlanabilir. Ek olarak, USG, obez bireylerde LP sahasının bulunması açısından daha başarılıdır.
Purpose: Lumbar puncture(LP) is a medical procedure in which a cerebrospinal fluid sample is taken for biochemical, microbiological and cytological examination. The aim of our study was to compare the ultrasonography (USG) method to the palpation method in determining the location of LP. Methods: 203 patients were included in the study. In the study, specifying location manually or with USG was performed by the same emergency medical assistant with USG certificate who completed his 4th year. The lumbar puncture site in the participating patients was determined and marked first by ultrasound and then by manual lumbar puncture. Results: The USG method was found to be significantly more successful than the manual method in determining the LP location(p=0.012) . The USG method was found to be significantly more successful in determining the LP site than the manual method, especially when the LP site was identified in the sitting position(p=0.031). In other positions, no difference was observed between the two groups (Right p=1, Left p=0.500). Body Mass Index(BMI) affects success during site location with USG (p=0.0001). Likewise, body mass index affected the success in identifying the LP site by the manual method(p=0.0001). The USG method was found to be significantly more successful than the manual method in determining the LP site in patients with BMI>25(p=0.012). Conclusion: During the LP location by palpation or USG, as the body mass index increased, the duration of location increased significantly, too. LP site can be identified by the USG in patients whose LP site cannot be specified by palpation. In addition, the USG is more successful in obese individuals in terms of locating the LP site.
  • 1. Kookier JC, Roberts JR, Hedges JR. Spinal puncture and cerebrospinal fluid examination. Clinical Procedures in Emergency Medicine (3rd ed.), Philadelphia: WB Saunders Company; 1998:1054–1077.
  • 2. Boon JM, Abrahams PH, Meiring JH, Welch T. Lumbar puncture: anatomical review of a clinical skill. Clin Anat 2004;17:544-553.
  • 3. Bogin IN, Stulin ID. Application of the method of 2-dimensional echospondylography for determining landmarks in lumbar punctures. Zh Nevropatol Psikhiatr Im S S Korsakova 1971;71:1810–1811.
  • 4. Straus SE, Thorpe KE, Holroyd-Leduc J. How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis? JAMA 2006;296:2012–2022.
  • 5. Ruzman T, Gulam D, Drenjancevic HI, Venzera-Azenic D, Ruzman N, Burazin J. Factors associated with difficult neuraxial blockade. Local Reg Anesth 2014;7 47–52.
  • 6. de Filho GR, Gomes HP, da Fonseca MH, Hoffman JC, Pederneiras SG, Garcia JH. Predictors of successful neuraxial block: a prospective study. Eur J Anaesthesiol 2002;19:447–451.
  • 7. Evans RW. Complications of lumbar puncture. Neurol Clin 1998;16:83–105.
  • 8. Heasley DC, Mohamed MA, Yousem DM. Clearing of red blood cells in lumbar puncture does not rule out ruptured aneurysm in patients with suspected subarachnoid hemorrhage but negative head CT findings. Am J Neuroradiol 2005;26:820–824.
  • 9. Mazor SS, McNulty JE, Roosevelt GE. Interpretation of traumatic lumbar punctures: who can go home? Pediatrics 2003;111:525–528.
  • 10. Ferre RM, Sweeney TW. Emergency physicians can easily obtain ultrasound images of anatomical landmarks relevant to lumbar puncture. Am J Emerg Med 2007;25:291–296.
  • 11. https://www.terason.com/ Access date: 05. 11. 2018.
  • 12. Pisupati D, Heyming TW, Lewis RJ, Peterson MA. Effect of ultrasonography localization of spinal landmarks on lumbar puncture in the emergency department. Ann Emerg Med 2004;44:83.
  • 13. "BMI Classification" Global Database on Body Mass Index. World Health Organization. 2012. Available at http://apps.who.int/bmi/index.jsp?introPage=intro_3.html
  • 14. Soni NJ, Franco-Sadud R, Schnobrich D, Dancel R, Tierney DM, Salame G, et al. Ultrasound guidance for lumbar puncture. Neurol Clin Pract 2016;6:358–368.
  • 15. Mofidi M, Mohammadi M, Saidi H, Kianmehr N, Ghasemi A, Hafezimoghadam P, et al. Ultrasound guided lumbar puncture in emergency department: Time saving and less complications. J Res Med Sci 2013;18: 303–307.
  • 16. Lahham S, Schmalbach P, Wilson SP, Ludeman L, Subeh M, Chao J, et al. Prospective evaluation of point-of-care ultrasound for pre-procedure identification of landmarks versus traditional palpation for lumbar puncture. World J Emerg Med 2018;7:173-177.
  • 17. Gottlieb M, Holladay D, Peksa GD. Ultrasound-assisted Lumbar Punctures: A Systematic Review and Meta-Analysis. Acad Emerg Med 2019;26:85-96.
  • 18. Sandoval M, Shestak W, Stürmann K, Hsu C. Optimal patient position for lumbar puncture, measured by ultrasonography. Emerg Radiol 2004;10:179-181.
  • 19. Nigrovic LE, Kuppermann N, Neuman MI. Risk factors for traumatic or unsuccessful lumbar punctures in children. Ann Emerg Med 2007;49:762-771.
  • 20. Glastein MM, Zucker-Toledano M, Arik A, Scolnik D, Oren A, Reif S. Incidence of traumatic lumbar puncture: experience of a large, tertiary care paediatric hospital. Clin Pediatr 2011;50:1005–1009.
  • 21. Thundiyil JG, O’Brien JF, Papa L. Optimal Positioning for Lumbar Puncture: Lateral Decubitus or Sitting? Ann Emerg Med 2007;50:11.
  • 22. Abo A, Chen L, Johnston P, Santucci K. Positioning for lumbar puncture in children evaluated by bedside ultrasound. Pediatrics 2010;125:e1149-1153.
  • 23. Lo MD, Parisi MT, Brown JC, Klein EJ. Sitting or tilt position for infant lumbar puncture does not increase ultrasound measurements of lumbar subarachnoid space width. Pediatr Emerg Care 2013;29:588-591.
  • 24. Molina A, Fons J. Factors Associated With Lumbar Puncture Success. Pediatrics 2006;118:842–844.
  • 25. Broadbent CR, Maxwell WB, Ferrie R, Wilson DJ, Gawne-Cain M, Russell R. Ability of Anaesthetists to İdentify a Marked Lumbar İnterspace. Anaesthesia 2000;55:1122–1126,
  • 26. Peterson MA, Pisupati D, Heyming TW, Abele JA, Lewis RJ. Ultrasound for Routine Lumbar Puncture. Acad Emerg Med 2014;21:130-136,
  • 27. Strony R. Ultrasound-Assisted Lumbar Puncture in Obese Patients. Crit Care Clin 2010;26:661-664.
  • 28. Stiffler KA, Jwayyed S, Wilber ST, Robinson A. The use of ultrasound to identify pertinent landmarks for lumbar puncture. Am J Emerg Med 2007;25:331–334.
  • 29. Edwards C, Leira EC, Gonzalez-Alegre P. Residency training: a failed lumbar puncture is more about obesity than lack of ability. Neurology 2015;84:e69-72.
  • 30. Nomura JT, Leech SJ, Shenbagamurthi S, Sierzenski PR, O'Connor RE, Bollinger M, et al. A randomized controlled trial of ultrasound-assisted lumbar puncture. J Ultrasound Med 2007;26:1341-1348.
Birincil Dil en
Konular Acil Tıp
Yayınlanma Tarihi Ocak 2021
Bölüm Araştırma Makalesi
Yazarlar

Orcid: 0000-0001-9346-7416
Yazar: Ömer ÇANACIK
Kurum: KAFKAS ÜNİVERSİTESİ, TIP FAKÜLTESİ
Ülke: Turkey


Orcid: 0000-0002-9773-5681
Yazar: Atakan YILMAZ (Sorumlu Yazar)
Kurum: FACULTY OF MEDICINE
Ülke: Turkey


Orcid: 0000-0003-4599-5833
Yazar: Ramazan SABIRLI
Kurum: FACULTY OF MEDICINE
Ülke: Turkey


Orcid: 0000-0001-6653-3756
Yazar: Mert ÖZEN
Kurum: FACULTY OF MEDICINE
Ülke: Turkey


Orcid: 0000-0002-8324-9471
Yazar: Murat SEYİT
Kurum: FACULTY OF MEDICINE
Ülke: Turkey


Orcid: 0000-0001-8342-4615
Yazar: İ̇brahim TÜRKÇÜER
Kurum: FACULTY OF MEDICINE
Ülke: Turkey


Orcid: 0000-0002-7425-1940
Yazar: Bülent ERDUR
Kurum: FACULTY OF MEDICINE
Ülke: Turkey


Orcid: 0000-0001-8783-8815
Yazar: Ahmet SAROHAN
Kurum: MANİSA SALİHLİ DEVLET HASTANESİ
Ülke: Turkey


Orcid: 0000-0001-6395-7924
Yazar: Hande ŞENOL
Kurum: FACULTY OF MEDICINE
Ülke: Turkey


Destekleyen Kurum Pamukkale Üniversitesi Bilimsel Araştırma Projeleri Koordinasyon Birimi
Proje Numarası 2015TPF034
Teşekkür Thanks to A.U. from Pamukkale University for presentation of abstract in the 4th Intercontinental Emergency Medicine Congress.
Tarihler

Yayımlanma Tarihi : 4 Ocak 2021

Bibtex @araştırma makalesi { patd769253, journal = {Pamukkale Tıp Dergisi}, issn = {}, eissn = {1308-0865}, address = {Pamukkale Üniversitesi Tıp Fakültesi Eğitim Blokları Kınıklı kampüsü 20070 Kınıklı, Denizli}, publisher = {Pamukkale Üniversitesi}, year = {2021}, volume = {14}, pages = {131 - 140}, doi = {10.31362/patd.769253}, title = {Comparison of lumbar puncture location with bedside ultrasonography and palpation in adult patients admitted to the emergency room}, key = {cite}, author = {Çanacık, Ömer and Yılmaz, Atakan and Sabırlı, Ramazan and Özen, Mert and Seyi̇t, Murat and Türkçüer, İ̇brahim and Erdur, Bülent and Sarohan, Ahmet and Şenol, Hande} }
APA Çanacık, Ö , Yılmaz, A , Sabırlı, R , Özen, M , Seyi̇t, M , Türkçüer, İ , Erdur, B , Sarohan, A , Şenol, H . (2021). Comparison of lumbar puncture location with bedside ultrasonography and palpation in adult patients admitted to the emergency room . Pamukkale Tıp Dergisi , 14. Cilt 1. Sayı , 131-140 . DOI: 10.31362/patd.769253
MLA Çanacık, Ö , Yılmaz, A , Sabırlı, R , Özen, M , Seyi̇t, M , Türkçüer, İ , Erdur, B , Sarohan, A , Şenol, H . "Comparison of lumbar puncture location with bedside ultrasonography and palpation in adult patients admitted to the emergency room" . Pamukkale Tıp Dergisi 14 (2021 ): 131-140 <https://dergipark.org.tr/tr/pub/patd/issue/56734/769253>
Chicago Çanacık, Ö , Yılmaz, A , Sabırlı, R , Özen, M , Seyi̇t, M , Türkçüer, İ , Erdur, B , Sarohan, A , Şenol, H . "Comparison of lumbar puncture location with bedside ultrasonography and palpation in adult patients admitted to the emergency room". Pamukkale Tıp Dergisi 14 (2021 ): 131-140
RIS TY - JOUR T1 - Comparison of lumbar puncture location with bedside ultrasonography and palpation in adult patients admitted to the emergency room AU - Ömer Çanacık , Atakan Yılmaz , Ramazan Sabırlı , Mert Özen , Murat Seyi̇t , İ̇brahim Türkçüer , Bülent Erdur , Ahmet Sarohan , Hande Şenol Y1 - 2021 PY - 2021 N1 - doi: 10.31362/patd.769253 DO - 10.31362/patd.769253 T2 - Pamukkale Tıp Dergisi JF - Journal JO - JOR SP - 131 EP - 140 VL - 14 IS - 1 SN - -1308-0865 M3 - doi: 10.31362/patd.769253 UR - https://doi.org/10.31362/patd.769253 Y2 - 2020 ER -
EndNote %0 Pamukkale Tıp Dergisi Comparison of lumbar puncture location with bedside ultrasonography and palpation in adult patients admitted to the emergency room %A Ömer Çanacık , Atakan Yılmaz , Ramazan Sabırlı , Mert Özen , Murat Seyi̇t , İ̇brahim Türkçüer , Bülent Erdur , Ahmet Sarohan , Hande Şenol %T Comparison of lumbar puncture location with bedside ultrasonography and palpation in adult patients admitted to the emergency room %D 2021 %J Pamukkale Tıp Dergisi %P -1308-0865 %V 14 %N 1 %R doi: 10.31362/patd.769253 %U 10.31362/patd.769253
ISNAD Çanacık, Ömer , Yılmaz, Atakan , Sabırlı, Ramazan , Özen, Mert , Seyi̇t, Murat , Türkçüer, İ̇brahim , Erdur, Bülent , Sarohan, Ahmet , Şenol, Hande . "Comparison of lumbar puncture location with bedside ultrasonography and palpation in adult patients admitted to the emergency room". Pamukkale Tıp Dergisi 14 / 1 (Ocak 2021): 131-140 . https://doi.org/10.31362/patd.769253
AMA Çanacık Ö , Yılmaz A , Sabırlı R , Özen M , Seyi̇t M , Türkçüer İ , Erdur B , Sarohan A , Şenol H . Comparison of lumbar puncture location with bedside ultrasonography and palpation in adult patients admitted to the emergency room. Pamukkale Tıp Dergisi. 2021; 14(1): 131-140.
Vancouver Çanacık Ö , Yılmaz A , Sabırlı R , Özen M , Seyi̇t M , Türkçüer İ , Erdur B , Sarohan A , Şenol H . Comparison of lumbar puncture location with bedside ultrasonography and palpation in adult patients admitted to the emergency room. Pamukkale Tıp Dergisi. 2021; 14(1): 131-140.
IEEE Ö. Çanacık , A. Yılmaz , R. Sabırlı , M. Özen , M. Seyi̇t , İ. Türkçüer , B. Erdur , A. Sarohan ve H. Şenol , "Comparison of lumbar puncture location with bedside ultrasonography and palpation in adult patients admitted to the emergency room", Pamukkale Tıp Dergisi, c. 14, sayı. 1, ss. 131-140, Oca. 2021, doi:10.31362/patd.769253