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(BQ) Part 1 book Interventional critical care has contents: Administrative considerations, airway procedures, vascular access procedures, vascular access procedures, neurological procedures, intracranial pressure monitoring, extraventricular drains and ventriculostomy.
Interventional Critical Care A Manual for Advanced Care Practitioners Dennis A Taylor Scott P Sherry Ronald F Sing Editors 123 Interventional Critical Care Dennis A Taylor • Scott P Sherry Ronald F Sing Editors Interventional Critical Care A Manual for Advanced Care Practitioners Foreword by W Robert Grabenkort and Ruth Kleinpell Editors Dennis A Taylor Carolinas HealthCare System Charlotte, NC, USA Scott P Sherry Department of Surgery Oregon Health and Sciences University Portland, OR, USA Ronald F Sing Carolinas HealthCare System Charlotte, NC, USA ISBN 978-3-319-25284-1 ISBN 978-3-319-25286-5 DOI 10.1007/978-3-319-25286-5 (eBook) Library of Congress Control Number: 2016944159 © Springer International Publishing Switzerland 2016 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland Foreword “By failing to prepare, you are preparing to fail.” Benjamin Franklin Increasingly, hospital systems and healthcare leaders are incorporating advanced practice providers to supply a 24/7 clinician presence in the intensive care unit (ICU) Nurse practitioners (NPs) and physician assistants (PAs) are an increasingly important component of the nation’s healthcare provider pool, and it has been identified that the addition of NPs and PAs to ICU teams is a strategy to meet ICU workforce needs As NPs and PAs assimilate into this new role, guidance is needed to assume proficiency in the role through mentoring and self-study This text, Interventional Critical Care: A Manual for Advanced Care Practitioners, is a needed resource for these practitioners In providing instruction on many of the technical skills needed to practice in the acute and critical care environment, the text is a useful reference for novice as well as experienced practitioners The scope of content covers topics related to essential aspects including credentialing, patient safety considerations, billing and coding for procedures, as well as a review of a number of invasive skills commonly performed in the management of acute and critically ill patients The insightful chapters are designed specifically for NPs and PAs to assist in learning the procedural techniques performed by the bedside critical care provider Each chapter is authored by an experienced practitioner describing not only the technical aspects of the procedure but also the clinical indications and pertinent practical considerations The editors have done a thorough job in choosing a wide range of procedures, and the chapter authors are seasoned practitioners who have performed the skills and share their expertise This text will undoubtedly be an essential reference for NPs and PAs practicing in the ICU setting We thank the editors for having the foresight to work on preparing the text and the chapter authors for sharing their knowledge and expertise to enhance NP and PA roles in the ICU Atlanta, GA, USA Chicago, IL, USA W Robert Grabenkort, PA, MMSc, FCCM Ruth Kleinpell, PhD, ACNP-BC, FCCM v Preface Over the past 10 years, the utilization of advanced practice providers (APPs) in both the intensive care unit (ICU) and operating room (OR) has increased dramatically With this surge in specialty providers, many educational programs have had difficulty providing the necessary didactic, psychomotor and affective skills, and experiences These are skills that are necessary for the APP working in these areas and for facility credentialing and privileging that would allow APPs to practice to the full extent of their license and ability In many cases, the lack of clinical experiences has contributed to this gap While APPs are very well grounded in the pathophysiology, pharmacology, and physical assessment of patient care, they may have not been exposed to the indications, contraindications, and technical aspects of performing many of these critical skills To fill this knowledge gap, we have envisioned and created a textbook that focuses on improving the knowledge and education of the APP in critical care procedures and skills The editors and chapter authors of this text were recruited from facilities and programs from across the United States They all actively practice in the ICU and OR and are considered content experts in their respective fields All chapters are authored by an APP and/or physician The majority of all authors are also designated as Fellows of the American College of Critical Care Medicine (FCCM) They have made significant contributions to patient care and the Society of Critical Care Medicine (SCCM) We hope you will enjoy reading and using this text as a reference in your daily practice in the ICU setting It has been a pleasure working with all of the chapter authors and contributors We, the editors, would like to express our appreciation to Patricia Hevey, Sonya Hudson, and Sarah Landeen at Carolinas HealthCare System for their contributions to editing and coordinating the efforts of this work We also express our appreciation to Michael Koy at Springer Publishing for all of his contributions and work on this project Charlotte, NC, USA Portland, OR, USA Charlotte, NC, USA Dennis A Taylor, DNP, ACNP-BC, FCCM Scott P Sherry, MS, PA-C, FCCM Ronald F Sing, DO, FCCM vii Contents Part I Administrative Considerations The Multidisciplinary ICU Team Dennis A Taylor, Scott Sherry, and Ronald F Sing The Surgical Setting: ICU Versus OR Gena Brawley, Casey Scully, and Ronald F Sing Patient Safety Roy Constantine and Ashish Seth 17 The Administrative Process: Credentialing, Privileges, and Maintenance of Certification Todd Pickard Billing and Coding for Procedures David Carpenter Part II 25 31 Airway Procedures Airway Management in the ICU Dennis A Taylor, Alan Heffner, and Ronald F Sing 43 Rescue Airway Techniques in the ICU Dennis A Taylor, Alan Heffner, and Ronald F Sing 51 Emergency Airway: Cricothyroidotomy Christopher A Mallari, Erin E Ross, and Ernst E Vieux Jr 59 Percutaneous Dilatational Tracheostomy Peter S Sandor and David S Shapiro 67 10 Diagnostic and Therapeutic Bronchoscopy Alexandra Pendrak, Corinna Sicoutris, and Steven Allen 81 Part III 11 Vascular Access Procedures Arterial Access/Monitoring (Line Placement) Sue M Nyberg, Daniel J Bequillard, and Donald G Vasquez 91 ix 23 219 Extraventricular Drains and Ventriculostomy 23.9 Keen’s Point Cranial location: posterior parietal Landmarks: 2.5–3 cm superior and 2.5–3 cm posterior to the ear Trajectory: perpendicular to the cortex Placement: frontal horn of the lateral ventricle Depth: 4–5 cm [20] 23.10 Dandy’s Point Fig 23.5 Leveling of transducer Depth: 6 h In non-emergent settings, LP is more often used in the evaluation of unexplained neurologic symptoms after neuroimaging to diagnose and treat pseudotumor cerebri, degenerative neurologic diseases, Guillain–Barré syndrome, neurosyphilis, tuberculosis, metastatic disease, or as a route of delivery for medications, specifically for spinal anesthesia, intrathecal administration of antibiotics, and chemotherapeutic agents, or to perform myelography © Springer International Publishing Switzerland 2016 D.A Taylor et al (eds.), Interventional Critical Care, DOI 10.1007/978-3-319-25286-5_24 225 C.J Schulz and A.W Asimos 226 24.3 Contraindications LP should not be performed in patients with intracranial mass or abscess as a sudden decrease in intracranial pressure may cause cerebral herniation It should also be avoided in any patient with epidural abscess or overlying skin infection as this may spread or introduce bacteria into the subarachnoid space [3] Caution should be used in performing LPs on patients with coagulopathy or underlying bleeding disorders as this may result in epidural hematoma formation If LP is indicated in the latter case, however, it may be necessary to reverse the coagulopathy, infuse clotting factors, or administer fresh frozen plasma prior to performing the procedure [4] 24.4 Intervertebral disc Vertebral body L1 Conus medularis Ligamentum flavum L2 Dura Arachnoid Subarachnoid space L3 L4 Cauda equina Filum terminale L5 Anatomy he ath er The brain floats in a thin layer of CSF that circulates within the ventricular system and extends to the subarachnoid space of the brain and spinal cord While the choroid plexus may produce up to 500 ml of CSF each day, about 150 ml is present at any given time [5] CSF provides protection from injury and filters cellular waste from brain tissue In its natural state, the fluid is a clear and colorless substance that consists primarily of water and is measured as mm H2O The brain and spinal cord are protected by three meningeal layers—the dura mater, arachnoid mater, and pia mater The dura mater, or “tough mother,” is the strong and dense outermost meningeal layer that contains and protects the underlying structures This area also contains the venous blood vessels that carry blood from the brain to the heart The arachnoid mater, or “spider mother,” forms the middle layer It consists of a thin layer that attaches to the dura mater with web-like collections of fibers that extend through the subarachnoid space attaching to the pia mater CSF circulates within this subarachnoid space and is constantly being reabsorbed into the bloodstream by the arachnoid villi The pia mater, or “tender mother,” is the thin and delicate innermost meningeal layer that envelops ga in e s‘ 15 Fig 24.1 Lumbar spine and cistern anatomy the brain and spinal cord This layer contains blood vessels that allow for blood exchange, but the layer is essentially non-permeable and is the structure most responsible for maintaining the blood–brain barrier The spinal cord originates from the medulla oblongata and terminates in the lumbar spine at the L3 level at birth Although there may be some variation during growth to adulthood, the spinal cord eventually terminates at about the L1 level This terminal end is called the conus medullaris Fibrous terminal threads, called filum terminale, proceed distally to the level of the sacrum and provide longitudinal support to the spinal cord Surrounding these threads is a bundle of spinal nerves which make up the cauda equina, or “horse’s tail,” which terminate at the S2 level As the spinal cord terminates, the subarachnoid space becomes more prominent This area is known as the lumbar cistern and is the area in which lumbar puncture is performed (Fig 24.1) 24 Lumbar Puncture and Drainage 24.5 Pre-Procedure Antibiotic administration should not be delayed by neuroimaging, completion of LP, or in awaiting test results when the clinical suspicion of meningitis or encephalitis is likely If a delay is anticipated, blood cultures should be obtained and empiric antibiotics should be administered Antibiotics administered even up to h prior to the procedure will not decrease CSF culture results due to the interval delay for the medication to cross the blood–brain barrier [4, 6] CT of the head should be considered in all patients of advanced age, those who are immunocompromised or have a seizure history, and in patients who have papilledema or any focal neurologic symptoms prior to performing LP When possible, consent should be obtained which discusses the risks and benefits of performing the procedure Explaining the steps of the procedure to the patient and family may help alleviate anxiety, but it will also provide the patient pertinent information regarding procedural expectations Parents or significant others may feel more comfortable stepping out of the room during the procedure, but they may also be seated in front of the patient to provide emotional support and comfort Fig 24.2 Lumbar puncture tray 227 Consider the use of conscious sedation, inhalant anesthetics, anxiolytic medications, local anesthetic injections, needle—free injections or topical anesthetic creams prior to the procedure on a case-by-case basis The use of needle-free jet injection of % lidocaine in infants seems to reduce pain before LP [7] The use of topical anesthetic cream is also beneficial and may allow for lower dosage need of intravenous analgesic agents especially in the pediatric population [8] Topical anesthetic creams, however, must be applied 30–60 prior to the procedure and may not be practical to use in the emergency setting In infants who require LP emergently, as little as 0.1 ml of oral sucrose on a pacifier provides pain relief in those 3 months of age [9] Ensure that adequate ancillary staff is available to assist with patient holding or equipment needs during the procedure Lumbar puncture tray (Fig 24.2) and other equipment should be readily available at the bedside Ideally, the patient should be placed in the lateral recumbent position which will allow for opening pressure measurements The patient should be instructed to lie in the fetal position C.J Schulz and A.W Asimos 228 near the edge of the bed, with the shoulders and pelvis squared on the bed, chin tucked and knees flexed to the chest while maintaining alignment of the spine Suggesting that the patient anteriorly flex the pelvis while simultaneously arching the low back will help flex the lumbar spine, thus opening the interspaces as opposed to protruding the sacrum which will close the interspaces Infants and obese patients may be placed in the upright position; however, opening pressure measurements are unable to be accurately obtained in this position In newborns, optimal performance can be achieved by sitting the infant with hips flexed with spinal needle trajectory angled 65–70° and with proper spinal needle depth calculated as 2.5 × weight in kilograms + mm [10] Infant pulse oximetry should be monitored during the procedure as over flexion of the head can lead to hypoxia and respiratory arrest Adults may be placed sitting upright on the examination bed while leaning over a tray stand to flex the lumbar spine The level of the iliac crest lies at the L4 spinous process (Fig 24.3) The interspace cephalad to this is L3–L4 which is the ideal interspace for subarachnoid access in adults and older children An additional interspace cephalad is L2–L3 which would also provide adequate subarachnoid access The subarach- noid space narrows significantly, however, caudal to L3–L4 which makes subarachnoid access in these interspaces much less successful The L1–L2 interspace should be avoided to ensure that the conus medullaris is not injured The interspace caudal to the L4 spinous process is L4–L5 which is the ideal LP site in infants and younger children 10 While palpating the spine of the iliac crest, locate the L4 spinous process The sulcus cephalad to the L4 spinous process and caudal to the L3 spinous process is the L3–L4 interspace (Fig 24.4) Using the thumbnail, an “X” can be impressed onto the skin overlying this area to identify the site at which lumbar puncture will be performed This should be made at the midpoint between and at the midline level of the spinous processes (Fig 24.5) It may help to remind the patient to flex the hips and arch the low back during the impression Evaluating the L2–L3 interspace at this point is appropriate especially if the L3–L4 interspace does not adequately flex or is difficult to identify Alternatively, a sterile skin marker can be used to create cross-hairs overlying this area While there may be no advantage to utilizing bedside ultrasound guidance in routine LPs, it may be a valuable tool in identifying spinal landmarks, reducing complications, and improving efficiency particularly in obese and pediatric patients [11–14] Fig 24.3 Anatomic landmark to identify L4 spinous process 24 Lumbar Puncture and Drainage Fig 24.4 Identifying the L3–L4 interspace Fig 24.5 Thumbnail impression marking the site of lumbar puncture 24.6 Procedure Ensure that the LP tray is opened in a sterile manner Don face mask, gown, and other personal protective equipment if needed Apply sterile gloves and inspect that all needed equipment is included in the LP tray 229 A sterile drape may be placed on the surface of the bed With sterile-gloved hands between a 1/3 fold of the sterile drape, carefully tuck it under the patient’s flank Open the povidone-iodine swabs or use povidone-iodine and sterile gauze to prepare the skin in sterile fashion If the patient has a povidone-iodine allergy, chlorhexidine may be used At the site of the impressed “X” or cross-hairs, begin sterile preparation in small circles moving peripherally to create an approximate 10 cm area of povidone-iodine coverage Three sterile cleansing passes should be performed while each time working from the central point to the periphery The paper backing strips on the fenestrated drape should be removed and the drape should be carefully applied over the patient’s iliac crest with the “X” impression or crosshairs in the open center portion of the fenestration There should be no visible areas of non-cleansed skin within the fenestration The povidone-iodine should be allowed to dry; however, any excess povidone-iodine can be wiped with sterile gauze While maintaining sterile field, it may be judicious at this point to reidentify the L3–L4 interspace and perform a repeat “X” impression with the thumbnail so that the site can be confirmed Using the filter straw, aspirate the lidocaine % into a cc syringe Remove the filter straw and affix a 25 gauge needle to the syringe At the center point of the “X” impression or cross-hairs, inject a small amount of lidocaine forming a wheal The needle can be withdrawn slightly and can be redirected toward the umbilicus in the trajectory that the spinal needle will follow so that a small amount of lidocaine can be injected deeper into the subcutaneous tissue Next, affix a 22 gauge needle to the syringe, and with the remainder of the lidocaine %, inject this deeper into the tissue following the same trajectory Providing infiltration bilaterally may offer additional anesthetic benefit Additional lidocaine may be required in larger-sized or obese patients to provide adequate local anesthesia While again suggesting that the patient anteriorly flex the pelvis and simultaneously arch 230 the low back, place the 20 gauge spinal needle bevel up to the L3–L4 interspace The sulcus will likely be difficult to appreciate at this point as the injected lidocaine may skew landmarks, and so entering the skin at the site of the lidocaine injection is most practical While 22 gauge spinal needles can be used in children of all ages, smaller spinal needle size can be considered given the clinical scenario Non-stylet needles or “butterfly needles” increase the risk of subarachnoid cyst evolution and should not be used Also consider that a in spinal needle may be required to successfully complete LP in obese patients It is important to maintain the spinal needle level in the midline of the interspace, but angled slightly toward the umbilicus While stabilizing your hand with the index and middle fingers against the patient’s back, brace the spinal needle with the thumb and index finger With the opposite hand, hold the spinal needle hub between your thumb and index and middle fingers and slowly advance through the tissues (Fig 24.6) If bone is encountered, simply withdraw slightly and redirect the spinal needle It is not uncommon for the patient to feel pain down one leg during this procedure, but the patient should be encouraged to remain as still as possible until the procedure is completed Fig 24.6 Hand position when advancing the spinal needle C.J Schulz and A.W Asimos Experienced providers will often feel the “pop” as the needle enters the dura, but this may not be readily identified in those less experienced in performing the procedure Advance the spinal needle slightly and remove the stylet It should be noted that a similar “pop” sensation may be felt with penetration of the ligamentum flavum; however, with the needle tip in this location, CSF drainage will not be seen with removal of the stylet 10 If the dural “pop” is not appreciated after the spinal needle has been advanced cm, it is good practice to remove the stylet and assess for fluid If there is no CSF drainage, replace the stylet, advance 1–2 mm, and reassess until subarachnoid space access has been achieved The CSF should appear clear or should clear as it is collected (Fig 24.7) Xanthochromia, or the yellowish discoloration of CSF when compared against a white background, suggests SAH and may be seen within h of symptom onset If the fluid appears clotted, lumbar puncture should be repeated at an alternate level as this is likely a “traumatic tap” or inadvertent venous plexus puncture Remember that it is not normal for blood to be in the subarachnoid space 11 Once access has been confirmed, attach the stopcock onto the spinal needle and secure the manometer to assess opening pressure 231 24 Lumbar Puncture and Drainage needed Ensure that the tubes are labeled in the order of collection or placed in sequential order to be labeled after the procedure 13 Replace the stylet and withdraw the needle Hold gentle pressure with a sterile gauze to the area and place a sterile dressing or adhesive bandage over the puncture site 24.7 Fig 24.7 CSF demonstrating blood-tinged clearing in the order of collection It is important to maintain control, and placement of the spinal needle during this as the manometer can be cumbersome to attach and remove from the spinal needle The opening pressure should be noted while the patient relaxes and slightly extends the lower extremities; however, there will be variation in the pressure with cough or respiration An opening pressure range of 80–200 mm H2O is normal in adults, while 50–100 mm H2O is normal in children In patients with elevated opening pressures consistent with pseudotumor cerebri, an appropriate amount of CSF should be drained to normalize pressure 12 After obtaining the opening pressure, empty this fluid into CSF tube #1 Close the stopcock and remove the manometer Next, collect CSF in tubes #2–4, ensuring that a minimum of ml is obtained in each tube Depending on the patient’s clinical indication for LP, additional CSF may be required and this can be placed in tube #4 A total of 4–8 ml should be obtained considering tests Post-Procedure All sharps should be accounted for and disposed of properly Previous teaching has suggested that the patient be placed supine for 1–24 h post-procedure as it had been postulated that this position may limit occurrence of post-LP headache While there is evidence that using atraumatic or blunt spinal needles may decrease occurrence of post-LP headache, there is no consensus that rest, intravenous fluids, patient position, or even spinal needle size prevents or limits occurrences of post-LP headache [15–18] Antibiotics should be administered when indicated if not completed prior to performing LP Analgesic or antiemetic medications should be provided if needed CSF collection tubes should be labeled appropriately and hand carried to the facility laboratory 24.8 CSF Tests Generally, tube #1 should evaluate cell count with differential, tube #2 protein and glucose, and tube #3 gram stain and culture A second cell count and differential as well as any additional tests can be evaluated via CSF collected in tube #4 Comparing the results from tube #1 and tube #4, the clinician should note stabilized or decreased CSF red blood cell (RBC) count which would suggest inadvertent venous plexus puncture, or a “traumatic tap.” The degree of CSF white blood cell count (WBC) pleocytosis can be calculated using the following corrective calculation: True CSF = ( measured CSF WBC ) ´ ( CSF RBC ´ blood WBC ) blood RBC C.J Schulz and A.W Asimos 232 or by calculating a CSF RBC to CSF WBC ratio of about 700:1 when peripheral cell counts are normal [19] An RBC count of >10,000 in the final collection tube significantly increases the odds of SAH [20] If SAH is suspected after review of test results, CT angiography of the head and neck should be performed In children, “traumatic tap” may be suggested if for every 1000 cell increase in CSF RBCs, CSF protein increases by 1.1 mg/dl [21]; however, elevation in CSF RBCs is also a common finding of HSV infection which should be considered in the setting of “traumatic taps.” Elevation in the CSF WBC (>5) is suggestive of meningitis; however, CSF WBC count alone does not distinguish between viral and bacterial cases In bacterial meningitis, cell counts are often markedly elevated and associated with an elevation in CSF protein and a decrease in CSF glucose, but normal cell counts may be seen especially in patients pretreated with antibiotics Gram stain demonstrating polymorphonuclear cells and organisms further suggests bacterial meningitis, whereas CSF culture will confirm the diagnosis Additional studies such as Venereal Disease Research Laboratory (VDRL), India Ink, herpes simplex virus (HSV), Cryptococcus, cytology, oligoclonal bands, arbovirus antibodies, and immune complexes may be considered depending on patient age, comorbidities, and clinical presentation 24.9 Complications While LP is widely considered to be a safe procedure, it is not risk-free The most widely reported complication is post-LP headache which may occur in 25 % of patients Presumed to be a result of intracranial hypotension, this headache is generally described as positional, specifically worse with sitting upright or standing and better with lying supine It is a self-limiting complication that may be treated with analgesic medications, caffeine, or by blood patch wherein venous blood is injected into the lumbar cistern via a second LP [22] While platelet aggregation may be the mechanism by which headache resolves, it is likely that the effect of increasing CSF pressure during the injection is responsible for immediate resolution of the headache [23–25] As the spinal needle penetrates several layers of tissue, minor bruising around or bleeding from the LP site may occur Back pain at the site of LP is common and may persist for several days and in rare cases for several months, but this should be self-limited and may be treated with NSAIDS or other analgesic medications It is possible that transient paresthesia or radiculopathic complaints occur during the procedure or shortly thereafter; however, rarely patients experience radiculopathic complaints beyond this Patients may find that back rest in the days immediately after the procedure may shorten the course of localized back pain; however, bed rest should generally not be recommended Subarachnoid cyst formation may occur as a complication of penetration into the subarachnoid space, but neurosurgical intervention is infrequently required LP site infection, epidural abscess, and meningitis are serious complications, but are rarely reported Patients presenting with these complications may be significantly ill or septic, and prompt identification and management is essential Epidural hematoma is a potential complication caused from venous plexus injury during the procedure Patients may complain of pain and have focal neurologic findings which may be a significant complication if cord compression leads to central cord ischemia The condition is usually diagnosed by magnetic resonance imaging (MRI) of the lumbar spine and may require neurosurgical intervention One of the more concerning complications is that of cerebral herniation which is catastrophic and often fatal Herniation usually occurs within the first 12 h after the procedure, most often in patients with previously unidentified brain mass or with significantly elevated intracranial pressure The mechanism of herniation is thought to be due to a sudden drop in pressure as a result of the procedure and may occur in up to % of patients undergoing LP who have bacterial meningitis [26, 27], although it may occur in patients with other neurologic conditions as well Cerebral herniation can occur in patients with normal head 24 Lumbar Puncture and Drainage CT and this alone does not infer that LP is safe to perform Clinical findings suggestive of impending herniation include deteriorating level of consciousness, Cheyne–Stokes respiration, posturing, or seizures LP should be avoided in these patients and interventions to control intracranial pressure should be the priority followed by emergent CT evaluation [27, 28] References Johnson KS, Sexton DJ Lumbar puncture: technique, indications, contraindications and complications in adults In: Post TW, editor UpToDate Waltham, MA: UpToDate; 2015 Perry JJ, Stiell IG, Sivilotti ML, Bullard MJ, Emond M, Symington C, Sutherland J, et al Sensitivity of computed tomography performed within hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study BMJ 2011;343:d4277 Reihsaus E, Waldbaur H, Seeling W Spinal 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lumbar punctures in a randomized pediatric leukemia trial Pediatr Blood Cancer 2015;62(1):85–90 Baxter AL, Cohen LL Pain management In: Strange GR, Ahrens WR, Schafermeyer RW, Wiebe R, editors Pediatric emergency medicine 3rd ed New York, NY: McGraw-Hill; 2009 10 Oulego-Erroz I, Mora-Matilla M, Alonso-Quintela P, Rodriguez-Blanco, Mata-Zubillaga D, de Armentia SL Ultrasound evaluation of lumbar spine anatomy in newborn infants: implications for optimal performance of lumbar puncture J Pediatr 2014;165(4):862–5 11 Peterson MA, Pisupti D, Heyming TW, Abele JA, Lewis RJ Ultrasound for routine lumbar puncture Acad Emerg Med 2014;21(2):130–6 233 12 Mofidi M, Mohammadi M, Saidi H, Kianmehr N, Ghasemi A, Hafezimoghadam P, Rezai M Ultrasound guided lumbar puncture in emergency department: time saving and less complications J Res Med Sci 2013;18(4):303–7 13 Kim S, Adler DK Ultrasound-assisted lumbar puncture in pediatric emergency medicine J Emerg Med 2014;47(1):59–64 14 Shaikh F, Brzezinski J, Alexander S, Arzola C, Carvalho JC, Beyenne J, Sung L Ultrasound imaging for lumbar puncture and epidural catheterisations; systemic review and meta-analysis BMJ 2013; 346:f1720 15 Waise S, Gannon D Reducing the incidence of postdural puncture headache Clin Med 2013;13(1):32–4 16 Jacobus CH Does bed rest prevent post-lumbar puncture headache? Ann Emerg Med 2012;59(2):139–40 17 Crock C, Orsini F, Lee KJ, Phillips RJ Headache after lumbar puncture: randomised crossover trial of 22-gauge versus 25 gauge needles Arch Dis Child 2014;99(3):203–7 18 Møller A, Afshari A, Bjerrum OW Diagnostic and therapeutic puncture performed safely and efficiently with a thin blunt needle Dan Med J 2013;60(9):A4684 19 Meurer WJ Central nervous system infections In: Marx JA, Hockberger RS, Walls RM, editors Rosen’s emergency medicine: concepts and clinical practice 8th ed Philadelphia, PA: Elsevier Saunders; 2014 20 Czuczman AD, Thomas LE, Boulanger AB, Peak DA, Senecal EL, Brown DF, Marill KA Interpreting red blood cells in lumbar puncture: distinguishing true subarachnoid hemorrhage from traumatic tap Acad Emerg Med 2013;20(3):247–56 21 Nigrovic LE, Shah SS, Neuman MI Correction of cerebrospinal fluid protein for the presence of red blood cells in children with a traumatic lumbar puncture J Pediatr 2011;159(1):158–9 22 Basurto OX, Martinez GL, Bonfill CX Drug therapy for treating post-dural puncture headache Cochrane Database Syst Rev 2011;8:CD007887 23 Kiki I, Gundogdu M, Alici HA, Yildirim R, Bilici M A simple, safe and effective approach to prevent postdural puncture headache: epidural saline injection Eurasion J Med 2009;41(3):175–9 24 Charsley MM, Abram SE The injection of intrathecal normal saline reduces the severity of postdural puncture headache Reg Anesth Pain Med 2001;26(4): 301–5 25 Turnbull DK, Shepherd DB Post-dural puncture headache: pathogenesis, prevention and treatment Br J Anaesth 2003;91(5):718–29 26 Rennick G, Shann F, de Campo J Cerebral herniation during bacterial meningitis in children BMJ 1993;306(6883):953–5 27 Joffe AR Lumbar puncture and brain herniation in acute bacterial meningitis: a review J Intensive Care Med 2007;22(4):194–207 28 Kwong KL, Chiu WK Potential risk of fatal cerebral herniation after lumbar puncture in suspected CNS infection HK J Paediatr 2009;14:22–8 ... specialties [11 ] © Springer International Publishing Switzerland 2 016 D.A Taylor et al (eds.), Interventional Critical Care, DOI 10 .10 07/978-3- 319 -25286-5_3 17 R Constantine and A Seth 18 Focusing... International Publishing Switzerland 2 016 D.A Taylor et al (eds.), Interventional Critical Care, DOI 10 .10 07/978-3- 319 -25286-5_2 G Brawley et al Fig 2 .1 Standard ICU set up including bed, monitor,... Ryan O’Gowan 99 13 Pulmonary Artery Catheter Insertion Britney S Broyhill and Toan Huynh 10 9 14 Peripherally Inserted Central Catheter Placement Christopher D Newman 11 5 15 Intraosseous