Abstract
Objective: To review the volume, indications, pre-procedure testing, success rate and complications in the Geisinger Neurology resident lumbar puncture (LP) clinic, and to identify areas for improvement.
Background: Neurology residents are expected to acquire the skills to perform LPs independently. A previous study reported that over 80% of LPs attempted by trainees were successfully completed. At our program we require postgraduate year (PGY) 2 residents to complete 5 successful LPs with direct supervision before performing them independently. We implemented a resident LP clinic to provide an early supervised clinical experience to meet this requirement.
Design/Methods: Retrospective review of patients seen in LP clinic during academic year 2019. LPs were performed without ultrasound guidance.
Results: There were 69 LP clinic slots available, and 50 were filled (72%). A total of 47 LPs were attempted: 2 by PGY1s (4%), 12 by PGY2s (26%), 18 by PGY3s (38%) and 15 by PGY4s (32%). The most common indication was demyelinating disease (36%). Overall, 45 patients (96%) had brain imaging and all had coagulation tests before the LP. Mean body mass index (BMI) of all patients was 30.4 Kg/m2. Out of 47 attempted LPs, 35 (74%) were successful. In only 1 of these cases the supervising attending successfully performed the LP after the resident’s attempt. Mean BMI for unsuccessful LPs was 38.3 Kg/m2. Complications occurred during or after 8 LPs (17%), of which 3 were unsuccessful. The most common complication was headache in 5 patients (11%) and only 1 required an epidural blood patch.
Conclusions: Resident LP clinic is a feasible method to provide longitudinal procedural training for residents. Our success rate was lower than what has been reported by others. Areas for improvement include adjustment of LP clinic slots to maximize use, prioritizing scheduling of PGY2s and incorporation of ultrasound to increase success rate.
Disclosure: Dr. Wyrostek has nothing to disclose. Dr. Whiting has nothing to disclose. Ms. Houtz has nothing to disclose. Dr. Avila has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alnylam Pharmaceuticals. Dr. Avila has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Akcea Therapeutics. Dr. Avila has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alnylam Pharmaceuticals. Dr. Avila has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Akcea Therapeutics.
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