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New ALERT - Improving Neonatal LP success rates through Positioning

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Herskovitz S (INOVA)

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New ALERT - Improving Neonatal LP success rates through Positioning

  1. 1. ALERT Presentation: Improving Success Rates of Neonatal Lumbar Punctures Through Positioning Scott Herskovitz – PEM Fellow (PGY-4) Inova Children’s Hospital INSPIRE @ IMSH 2016 – San Diego, CA / USA International Network for Simulation-based Pediatric Innovation, Research and Education
  2. 2. – Recent studies with ultrasound demonstrate that the greatest interspinous space achieved was in seated position with flexion of hips – Decreased O2 saturations most notable in the lateral decubitus position with knees to chest – Success amongst novices range from 35- 50% International Network for Simulation-based Pediatric Innovation, Research and Education Background
  3. 3. • P: Interns performing lumbar punctures in pediatric patients <3mo • I: Institution of seated positioning • C: Lateral decubitus positioning • O: Success rates, number of attempts, adverse events International Network for Simulation-based Pediatric Innovation, Research and Education PICO / Research Question
  4. 4. • Add-on to INSPIRE LP MOC Study • New interns will receive educational intervention • After receiving education, intern randomized to start position seated or lateral position switching every 3 months • Data collected: attempts, position, success rate, adverse events, pt age, pt weight, pt sex International Network for Simulation-based Pediatric Innovation, Research and Education Approach / Design
  5. 5. • ALERT Presentation 1/2016 • IRB Submission Addendum March/April 2016 • Intern Orientation/Training June/July 2016 • Recruitment / Data Collection July-December 2016 • Data Analysis January-February 2017 • Abstract Presentation April 2017 • Manuscript Preparation June 2017 International Network for Simulation-based Pediatric Innovation, Research and Education Timeline
  6. 6. 1. Should randomization occur at the site level vs individual level? 2. What is reasonable timeline for switching positions? 3. How many attempts should be allowed before switching positions if at all? International Network for Simulation-based Pediatric Innovation, Research and Education 3 questions to improve study
  7. 7. At INSPIRE @ IMSH 2016: Obtain feedback for feasibility of study In 2 months: Incorporate feedback to obtain study approval and IRB addendum submission International Network for Simulation-based Pediatric Innovation, Research and Education Goals to accomplish
  8. 8. Scott Herskovitz Inova Children’s Hospital Scott.herskovitz@gmail.com, 661-645- 9758 Website / QR Code International Network for Simulation-based Pediatric Innovation, Research and Education Contact Information

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