Hospital Procedures Consultants

Which cirrhotic patients are at high risk for bleeding during hospital procedures?

More Articles – Arterial line placement, central line placement, chest tubes, Cirrhosis, Featured, HPC Updates, Lumbar Puncture, Paracentesis, Thoracentesis, Tube Thoracostomy
More Tags – , , , , , , , , ,
This blog will offer some expert recommendations to help guide the safety of hospital procedures at different platelet and coagulation profiles.  Unfortunately, there are no strong evidence-based guidelines for hospital procedures dedicated to the study of patients with decompensated cirrhosis.…
Read More

Bedside Ultrasound Increases the Success Rate for Difficult Lumbar Punctures

More Articles – Featured Procedure, HPC Updates, Lumbar Puncture, PROCEDURE OF THE WEEK, Ultrasound-Guided Lumbar Punctures, ultrasound-guided procedures
More Tags – , , , ,
The traditional landmark-guided needle lumbar puncture technique was first described by Heinrich Quincke in 1891[1]This technique utilizes the iliac crest and the posterior lumbar spinous processes to determine the optimal sites for spinal needle introduction in either the L3-4 or…
Read More

Guidelines for Antiplatelet and Anticoagulation Discontinuation before a Lumbar Puncture

More Articles – Anticoagulation, antiplatelets, epidural hematoma, Featured, HPC update, Lumbar Puncture
More Tags – , , , , ,
This blog summarizes the guidelines by the European Society of Anesthesiology (ESA), the American Society of Regional Anesthesia (ASRA) and the Association of British Neurologists regarding the timing of antiplatelet and anticoagulation discontinuation before a lumbar puncture.  The following table…
Read More

Periprocedural Bleeding Risk for Thrombocytopenia, Coagulopathy, Antiplatelets and Anticoagulation

More Articles – Anticoagulation, antiplatelets, central lines, Chest tube, chest tubes, coagulopathy, Featured, HPC update, Lumbar Puncture, Paracentesis, procedures, Thoracentesis
More Tags – , , , , , , , , , ,
This blog summarizes the 2019 Society of Interventional Radiology (SIR) for Periprocedural Management of Image-guided Procedures with regards to thrombocytopenia, coagulopathies, antiplatelets and anticoagulation.  The SIR guidelines are summarized as follows: Anticoagulation with heparin, LMWH, fondaparinux, argatroban, warfarin, DOAC, clopidogrel, ticagrelor…
Read More

Performing Procedures on Patients Who Take Dabigatran, Rivaroxaban, and Apixaban

More Articles – Anticoagulants and Procedures, Featured Procedure, HPC Updates, Lumbar Puncture
More Tags – , , ,
Over the past several years, there has been a dramatic increase in the use of the new oral anticoagulants (Dabigatran, Rivaroxaban, and Apixaban).  The popularity of these medications stems not only from aggressive pharmaceutical monitoring to physicians and to the…
Read More

Safety of Lumbar Puncture in Adults and Children with Thrombocytopenia

More Articles – epidural hematoma, Featured, HPC Updates, Lumbar Puncture, thrombocytopenia
More Tags – , ,
Traditionally, it has been promulgated by anesthesiologists that you need a platelet count of 100,000 to safely perform neuraxial regional anesthesia (spinal and epidural anesthesia).  This practice pattern has continued even though Children’s Hospitals routinely perform intrathecal injections for prophylactic chemotherapy with…
Read More

Risks for Post-Dural Puncture Headaches after Lumbar Puncture

More Articles – Featured Procedure, Headache, HPC Updates, Lumbar Puncture, Post-dural puncture headache, spinal headache
More Tags – , , ,
Diagnostic lumbar punctures aid in the diagnosis of infections and diseases of the central nervous system. Life-threatening events from lumbar punctures are rare, but post–lumbar (dural) puncture headaches (PDPH) occur in 1% to 36% of patients, depending on the needle…
Read More

Ultrasound-Guided Lumbar Puncture More Successful than Traditional LP in Infants

More Articles – HPC Updates, Infants, Lumbar Puncture, Ultrasound, Ultrasound-guided lumbar puncture
More Tags – , , , ,
Lumbar puncture (LP), commonly performed in infants to rule out meningitis, is often not successful in the hands of inexperienced operators. Investigators conducted a study of 128 infants younger than 6 months. They compared traditional LP to LP preceded by…
Read More

Atraumatic Spinal Needles Significantly Decrease the Risk of Post-Dural Puncture Headaches or Spinal Headaches

More Articles – ATN, Atraumatic spinal needles, HPC Updates, Lumbar Puncture, PDPH, Post-dural puncture headache, TN, Traumatic needles
More Tags – , , , , , , ,
According to recent studies, atraumatic needles (ATN) reduce the rate of post-dural puncture headache (PDPH) when compared to traumatic needles (TN – or bevel-tip needles such as Quincke needles) (27% vs 60%).  Also, the mean duration of PDPH from ATN…
Read More

Differences Between Lumbar Punctures in Children Vs Lumbar Punctures in Adults

More Articles – CSF Lactate Level, HPC Updates, Lumbar Puncture, Pediatric Lumbar Puncture
More Tags – , , ,
Pediatric lumbar punctures can have much higher success rates when proper positioning and technique are emphasized. The position should be the lateral decubitus position with hips flexed, but the neck does not need to be flexed. The spinal cord ends…
Read More

Essential to Administer Antibiotics Immediately if Bacterial Meningitis is Suspected

More Articles – Acute Bacterial Meningitis, CT Scan, Guidlelines, HPC Updates, Lumbar Puncture
More Tags – , , , ,
Prior to the revised Swedish lumbar puncture guideline, a CT scan was often performed prior to lumbar puncture when acute bacterial meningitis was suspected. Taking the time to perform a CT scan of the head before lumbar puncture delays treatment…
Read More

Earlier Lumbar Puncture for Suspected Acute Bacterial Meningitis Leads to Better Outcomes

More Articles – bacterial meningitis, Lumbar Puncture, meningitis
More Tags – , ,
Although adult bacterial meningitis (ABM) is rare, the outcomes can be devastating. An area of controversy concerns when to perform lumbar puncture (LP). Because of the possibility of brain herniation, it has been recommended that cerebral computed tomography (CT) be…
Read More

Lumbar puncture characteristics of traumatic LP versus subarachnoid hemorrhage

More Articles – HPC Updates, Lumbar Puncture, subarachnoid hemorrhage, traumatic lumbar puncture
More Tags – , ,
How to Differentiate Traumatic Lumbar Punctures from Aneurysmal Subarachnoid Hemorrhage The diagnosis of subarachnoid hemorrhage (SAH) often requires lumbar puncture, however, in an estimated 10% to 30% of procedures that are traumatic, iatrogenic bleeding can complicate diagnosis. To identify cerebrospinal…
Read More

Categories

Menu