Under what circumstances do you recommend POCUS guidance for lumbar puncture?

If the circumstances allow for it, I would use ultrasound for guidance for LP every time a LP is performed. This allows for continued practice in identification of the landmarks and improves accuracy in POCUS when it's truly needed, as in obese patients, where landmarks are difficult to palpate.

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I agree with Dr. @Dr. First Last. As with many other skills in medicine, repetition is key to mastering POCUS skills. So, if available, I always use ultrasound to assist with lumbar punctures. You are improving your skills and increasing your success rate at the first needle pass, improving patient ...