Recommendations on the use of ultrasound guidance for adult lumbar puncture: A position statement of the Society of Hospital Medicine

Nilam J. Soni, Ricardo Franco-Sadud, Ketino Kobaidze, Daniel Schnobrich, Gerard Salame, Joshua Lenchus, Venkat Kalidindi, Michael J. Mader, Elizabeth K. Haro, Ria Dancel, Joel Cho, Loretta Grikis, Brian P. Lucas, Nilam Soni, Ricardo Franco-Sadud, Jeff Bates, Ria Dancel, Nitin Puri, Ricardo Franco, Benji MatthewsSaaid Abdel-Ghani, Sophia Rodgers, Martin Perez, Joel Cho, Benji Matthews, Kreegan Reierson, Anjali Bhagra, P. Trevor, Nilam J. Soni, Ricardo Franco, Gerard Salame, Josh Lenchus, Venkat Kalidindi, Ketino Kobaidze, Brian P. Lucas, David Tierney, Trevor P. Jensen, Robert Arntfield, Michael Blaivas, Richard Hoppmann, Paul Mayo, Vicki Noble, Aliaksei Pustavoitau, Kirk Spencer, Vivek Tayal, Mahmoud El Barbary, Loretta Grikis, Daniel Brotman, Satyen Nichani, Susan Hunt, Nick Marzano

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


1) When ultrasound equipment is available, along with providers who are appropriately trained to use it, we recommend that ultrasound guidance should be used for site selection of lumbar puncture to reduce the number of needle insertion attempts and needle redirections and increase the overall procedure success rates, especially in patients who are obese or have difficult-to-palpate landmarks. 2) We recommend that ultrasound should be used to more accurately identify the lumbar spine level than physical examination in both obese and nonobese patients. 3) We suggest using ultrasound for selecting and marking a needle insertion site just before performing lumbar puncture in either a lateral decubitus or sitting position. The patient should remain in the same position after marking the needle insertion site. 4) We recommend that a low-frequency transducer, preferably a curvilinear array transducer, should be used to evaluate the lumbar spine and mark a needle insertion site. A high-frequency linear array transducer may be used in nonobese patients. 5) We recommend that ultrasound should be used to map the lumbar spine, starting at the level of the sacrum and sliding the transducer cephalad, sequentially identifying the lumbar spine interspaces. 6) We recommend that ultrasound should be used in a transverse plane to mark the midline of the lumbar spine and in a longitudinal plane to mark the interspinous spaces. The intersection of these two lines marks the needle insertion site. 7) We recommend that ultrasound should be used during a preprocedural evaluation to measure the distance from the skin surface to the ligamentum flavum from a longitudinal paramedian view to estimate the needle insertion depth and ensure that a spinal needle of adequate length is used. 8) We recommend that novices should undergo simulation-based training, where available, before attempting ultrasound-guided lumbar puncture on actual patients. 9) We recommend that training in ultrasound-guided lumbar puncture should be adapted based on prior ultrasound experience, as learning curves will vary. 10) We recommend that novice providers should be supervised when performing ultrasound-guided lumbar puncture before performing the procedure independently on patients.

Original languageEnglish (US)
Pages (from-to)591-601
Number of pages11
JournalJournal of hospital medicine
Issue number10
StatePublished - 2019

Bibliographical note

Funding Information:
Brian P Lucas: Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development and Dartmouth SYNERGY, National Institutes of Health, National Center for Translational Science (UL- 1TR001086). Nilam Soni: Department of Veterans Affairs, Quality Enhancement Research Initiative (QUERI) Partnered Evaluation Initiative Grant (HX002263- 01A1).

Publisher Copyright:
© 2019 Society of Hospital Medicine.


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