Improving Success Rates in Infant Lumbar Punctures: A Quality Improvement Initiative Using Ultrasound Guidance

Infant lumbar punctures (LPs) are common procedures in the pediatric emergency department, yet first-attempt success remains challenging. Point-of-care ultrasound improves landmark identification and has been associated with higher LP success rates. We implemented a quality improvement project aiming to reduce multiple LP attempts in children younger than 24 months from 55% to 30% over 1 year through an ultrasound-guided LP education program. The intervention included an online module, hands-on simulation, competency assessment, and Plan-Do-Study-Act cycles. Chart review of 167 patient encounters compared baseline and postintervention outcomes. Multiple-attempt LPs decreased from 55.1% to 43.5%, traumatic LPs declined from 47.0% to 35.6%, overall LP success increased from 84.7% to 85.5%, and ultrasound-guided LP use rose from 5.1% to 14.5%. Although limited sample size prevented statistical significance, integrating phantom simulation and static ultrasound guidance into infant-specific training shows promise for reducing procedural attempts and traumatic LPs while improving patient, family, and clinician experiences.