Safety First: Use of the Gertie‐Marx Needle for Lumbar Punctures

1Cedars‐Sinai Medical Center, Los Angeles, CA
2College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA
3Cedars‐Sinai Medical Center, Los Angeles, CA

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 67

Background:

Despite the strength of the 2005 AHRQ recommendations for the use of the Gertie‐Marx® spinal needle (GM) for lumbar punctures (LPs), the use of this device has not reached critical mass at our institution. This delay in adaptation mirrors the path of other technological advances that initially failed to be embraced by physicians (ultrasound for vascular access, for example). To design an effective rollout strategy for our institution, we started by evaluating the experience of a single high‐volume proceduralist during his successful transition from the standard Quinke needle (QN) to the GM.

Methods:

A retrospective analysis was done on the first 200 LPs performed with the GM needle by 1 proceduralist. The CSF for every LP was also evaluated, using the newly defined indices the atraumatic index (ATI; a marker of quality, defined as the number of LPs that result in 0 RBCs in any tube divided by the total number of LPs performed) and the traumatic index (TI; a marker of safety, defined as the number of LPs that produced blood‐tinged/bloody CSF divided by the total number of LPs performed).

Figure 1. Gertie‐Marx needle.

Results:

It took a total of 285 LPs over 327 days to reach 200 GM LPs. The 4 quartiles were defined to each encompass 50 LP attempts with the GM, even if LPs were also performed with the QN during those periods. Results and trends are depicted in Table 1.

Table 1. Performance by Quartiles (Defined as 50 GM Cases)

Conclusions:

Four important lessons were learned: (1) the ATI and TI are reliable indices for measuring LP quality and safety, given that these results mirror the previously established superiority of the GM needle; (2) based on the frequency of QN usage, at least 50 LPs were required with the GM before a reliable level of comfort could be achieved (as reflected in a drop in QN use); (3) safety benefits were seen immediately, as reflected by a GM TI of 0 in the first quartile, thus making the device worthwhile even for low‐volume users; and (4) even after a level of mastery with the GM had been achieved, the proceduralist continued to rely on the QN for a handful of difficult cases. Based on these conclusions, the use of the GM should be strongly encouraged for LPs. The QN will need to remain in the LP tray during the rollout rather than opting to replace the QN with the GM, and orientation and training will be required.

Author Disclosure:

B. Rosen, none; M. Ault, none; B. Ault, none.

To cite this abstract:

Rosen B, Ault B, Ault M. Safety First: Use of the Gertie‐Marx Needle for Lumbar Punctures. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 67. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/safety-first-use-of-the-gertiemarx-needle-for-lumbar-punctures/. Accessed September 22, 2019.

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