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Clinical Indication

Need to safely perform a procedure, such as a Lumbar Puncture in an obese patient

Probe Selection

Linear and/or Curvilinear probes

How To:

1. Make sure the patient is positioned before you scan-skin will shift and your US guided approach will NOT work unless the patient is put in position and then does not move for the duration of the procedure. 

2. Attempt to find the posterior-superior iliac spine to guide the approximate level at which to perform the LP. If you cannot palpate it, you can find the sacrum with the US and count the vertebrae as you move cephalad until you get to the appropriate space(s).

3. Obtain a sagittal view of the L4 and L5 spinous processes marking the space between them where the interspinous ligament lies. Make the appropriate marks on the patient. 

4. Obtain a transverse view of L4 marking the skin where the spinous process comes the closest to the skin surface. 

5. Obtain a transverse view of the L5 spinous process marking the skin where the spinous process comes closest to the skin.

6. You will be left with a box approximately 2-3cm in transverse by 3-4cm in cephalad-caudad.

7. Place your needle in the center of the box you made aiming like you would for the traditional landmark approach