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Medical devices
Development of a real time ultrasound guided lumbar puncture device
  1. Bingwen Eugene Fan1,2,3,4,
  2. Chuang Kiat Desmond Soh5,
  3. Hee Chuan Darryl Heng3,4,6,
  4. Lee Long Eddie Woo5,
  5. Wern Hsien Bin3,4,6
  1. 1 Department of Haematology, Tan Tock Seng Hospital, Singapore
  2. 2 Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore
  3. 3 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
  4. 4 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  5. 5 Medulla Pro Technology Pte Ltd, Trendlines Medical Singapore, Singapore
  6. 6 Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore
  1. Correspondence to Dr Bingwen Eugene Fan, Department of Haematology, Tan Tock Seng Hospital, Singapore; Bingwen_Eugene_Fan{at}ttsh.com.sg

https://doi.org/10.1136/bmjinnov-2021-000921

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    What are the new findings

    • Development of a state-of-the-art device to aid in real-time ultrasound guidance for lumbar puncture, so that the most direct path can be accessed, with consistent success.

    • Preliminary testing of the device prototype has demonstrated that the device is able to deflect ultrasound waves without significant image degradation and enables successful lumbar puncture on phantom model and porcine cadaver trial.

    How might it impact on healthcare in the future

    • Higher success rate of lumbar puncture on first attempt, leading to improved clinical outcome, patient safety and satisfaction.

    • Potential for device technology to be extended to other ultrasound-guided needle procedures such as abdominal paracentesis, pleural and pericardial taps, and regional anaesthetic blocks.

    Introduction

    Background

    The lumbar puncture (spinal tap) is a bedside procedure performed at the lumbar region and is both a therapeutic and diagnostic procedure.1 It is primarily used in neurology for the diagnosis of both acute and chronic neurological conditions,2 by obtaining cerebrospinal fluid (CSF) for testing and to measure the opening pressure. This procedure is key to making the diagnosis of infections of the central nervous system (CNS) and neurodegenerative diseases such as multiple sclerosis and normal pressure hydrocephalus. The lumbar puncture is also commonly performed in several other specialties including emergency medicine, paediatrics, haematology-oncology, anaesthesia and infectious diseases. For instance, in haematology-oncology, CSF is used to detect CNS involvement by malignancy and lumbar puncture is required to administer intrathecal chemotherapy for treatment or prophylaxis of CNS malignancies.3 In anaesthesia, a lumbar puncture is performed to inject local anaesthetic into the CSF as part of spinal anaesthesia.4

    During lumbar puncture, a needle is inserted in the lower back, through the lumbar intervertebral space, to access the subarachnoid space. CSF is obtained if needed. The entry point is commonly identified using palpation and anatomical surface landmarks, and the procedure is routinely carried out without any assisting or …

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    Footnotes

    • Twitter @eugenefanbw

    • Contributors BEF conceived the problem statement. BEF and WHB defined the clinical problem. All authors were involved in the design and evaluation of the device. BEF wrote the initial manuscript, with all authors contributing substantially to the acquisition, analysis and interpretation of data, critical revision of manuscript for important intellectual content.

    • Funding The study was supported by funding from Enterprise Singapore (SGTECH Proof of Concept Grant /Award Number (COGRSUSGT1900008) and SGTECH Proof of Value Grant/Award Number (COGRSUSGT200017V01).

    • Disclaimer The device is patented under patent number: PCT/SG2019/050417. https://patents.google.com/patent/WO2020040701A1/.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.