E2392. Improving Image-Guided Lumbar Puncture CSF Collection Time and Rate of Dry Spinal Taps by Optimizing Preprocedure Hydration and NPO Status
  1. Maggie Barghash ; UTMB
  2. Marco Colasurdo; UTMB
  3. Esraa Al-Jabbari; UTMB
  4. Hasan Azeem Khan; UTMB
  5. Irfan Masood; UTMB
  6. Huda Al-Jadiry; UTMB
Dehydration is thought to be the culprit in many failed lumbar punctures in our institution. This occurrence lasted despite frequent verbal communications with referring providers in an attempt to cease the practice of placing patients on NPO status prior to IR guided lumbar punctures. Our goal was to evaluate whether the incidence rate of failed lumbar puncture will decrease and the rate of CSF collection will increase after implementation of an EMR message emphasizing preprocedure hydration.

Materials and Methods:
Our project was performed in three campuses of our university hospital. Consecutive patients undergoing a fluoroscopically guided lumbar puncture from April 3rd, 2020 to March 31st 2021 were identified and collected in a computerized database. We created a hard stop in our EMR with a message necessitating acknowledgement before providers can carry forward with their orders. The EMR message entailed the unnecessity of placing patients on NPO status solely in preparation for this procedure and of adequately hydrating patients in the instance they are on NPO status for other reasons. The protocol change (i.e., EMR message) was performed on October 1st, 2020. Any lumbar puncture yielding less than 2 ml CSF was considered a failed lumbar puncture. The rate of failed lumbar puncture and the CSF collection time was obtained and calculated from the chart and compared between the two groups. The Chi square test and t-test for independent proportions were performed for statistical analysis.

Lumbar punctures included in our study constituted 97 pre-intervention and 64 post-intervention LPs. Failed lumbar puncture accounted for 5 of the 97 (5.2%) of the pre-intervention group and 1 of the 64 (1.6 %) of the post-intervention group, with a p-value of (0.4). CSF collection time was 71.8 min versus 50.5 min in pre and post intervention groups respectively, with a p - value of (p < 0.01) .

Creating an EMR message to notify referring physicians about adequate pre-procedural hydration results in significantly lower CSF collection time in the IR suite by approximately 21 minutes. This represents a potential cost-effective initiative, especially in busy work flow services/institutions. The lack of significance in lowering the rate of failed taps between the pre- and post-intervention groups may be attributed to the small sample size, further research with a larger dataset may be helpful in validating our theory.