Lumbar puncture on the morbidly obese

Shadowfax does an LP on someone with a BMI over 50. This can certainly lead to a loss of anatomical landmarks – and essentially the procedure is done blind.

Comments

Anonymous
Now add CSF manometry to that.
Anonymous
Yeah, I bet you’ll lose landmarks when you take someone that fat, and lay the person lateral.
Sit the patient up, for Pity’s sake.
Anonymous
Would have sat patient up myself…however, according to the post, the patient was given dilaudid [though she was awake enough to share in the "joy" of the tap]
Mike
You cant get an OP with a patient sitting up.
Anonymous
Do you really need to give Dilaudid for a lumbar puncture?
I never felt a need to do that, having done a thousand-plus in hospital and office settings.
I suppose there’s always exceptions, guess I’ve just not run into that problem. And of course, I’ve had tough spinals and huge patients in those numbers.
I also would have a concern about mental status. Wasn’t this particular LP to rule-out meningitis? Now you’ve got opiates on board.
But hey, I wasn’t there, don’t know what particulars the doc faced.
One problem is the spinal kits usually have these dinky little 2-cc vials of local anesthetic. People get the idea that’s all you can use on the patient. Now they fail at one level, want to try another level, or get landmarks wrong, or want to try a paramedian approach, etc.
Instead of the Dilaudid, I would advise to get more local anesthetic instead. Drop it into the tray, same as a surgeon can get local anesthetic dropped onto the tray to infiltrate a surgical incision.
IMHO…….
Anonymous
The decision may be whether it’s more important to get an opening pressure, or a CSF sample to rule-out infection.

Lumbar puncture on the morbidly obese

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