Trang Jacinta, Ku Dominic, Snelling Peter J
Department of Paediatrics, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Department of Radiology, John Hunter Hospital, Newcastle, New South Wales, Australia.
Emerg Med Australas. 2025 Aug;37(4):e70103. doi: 10.1111/1742-6723.70103.
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.
腰椎穿刺（LPs）是一种侵入性操作，对于儿科患者而言，频繁出现创伤性穿刺或穿刺失败的情况，颇具挑战性。床旁超声（POCUS）是一种常用于操作引导的非侵入性工具。本叙述性综述的目的是评估当前围绕在进行儿科腰椎穿刺时使用超声辅助（标记盲穿针插入点）或超声引导（直接可视化针）技术的文献。使用PubMed、Embase和谷歌学术进行了文献综述，研究结果以叙述形式呈现。超声可改善合适的腰椎穿刺插入部位的识别。POCUS提高了采用辅助技术进行腰椎穿刺尝试的首次成功率。由于婴儿缺乏骨化，可识别脊髓圆锥和硬膜囊的深度。腰椎穿刺失败时出现血肿可能表明需要推迟进一步尝试。然而，目前缺乏证据表明POCUS能常规辅助大龄儿童进行腰椎穿刺。在大龄儿童中，超声的使用可能仅限于困难的腰椎穿刺情况，如解剖结构异常或棘突难以触及。超声引导技术提高了各年龄段腰椎穿刺的成功率，但这是一项主要由放射科医生执行的先进技术。越来越多的证据表明POCUS有助于婴儿腰椎穿刺成功。它在大龄儿童困难的腰椎穿刺中可能也有作用，但直接引导需要更高水平的专业知识。仍需要高质量的研究来确定超声在儿科腰椎穿刺中的确切作用。
