The Utility of Point-Of-Care Ultrasound for Paediatric Lumbar Puncture: A Narrative Review

Abstract

Lumbar punctures (LPs) are an invasive procedure that can be challenging with frequent traumatic or failed attempts in paediatric patients. Point-of-care ultrasound (POCUS) is a non-invasive tool frequently used for procedural guidance. The objective of this narrative review was to evaluate the current literature surrounding the use of ultrasound-assisted (marking for blind needle insertion) or ultrasound-guided (direct needle visualisation) techniques when performing paediatric LPs. A literature review was conducted using PubMed, Embase, and Google Scholar, with findings described in narrative format. Ultrasound can improve the identification of a suitable LP insertion site. POCUS increases first-pass success rates of LP attempts in infants with an assisted technique. Due to the lack of bone ossification in infants, the conus medullaris and depth of the thecal sac can be identified. The presence of a haematoma in the setting of failed LP may indicate the need to delay further attempts. However, there is currently a lack of evidence that POCUS routinely aids LPs in older children. The use of ultrasound in older children may be reserved for difficult LPs, such as abnormal anatomy or impalpable spinous processes. The ultrasound-guided technique improves LP success rates in all ages, but is an advanced technique mostly performed by radiologists. There is growing evidence that POCUS can assist with infant LP success. It may also have a role in difficult LPs in older children, but direct guidance requires a higher level of expertise. High-quality research is still required to determine the exact role of ultrasound for paediatric LPs.