We have had a run on very sick children in our emergency department lately.
One 2 year old patient had a seizure and just didn’t look good.
Blood glucose good. Blood pressure good. Temperature 101.2 degrees. Not super high, but is this meningitis or is the temperature up from the constant seizing? I ordered antibiotics to be safe.
Then comes the lumbar puncture.
Damned if I didn’t hit the “Vein of WhiteCoat”.
If you haven’t performed a lumbar puncture on an infant before, the rest of this post isn’t going to make much sense to you. On the other hand, if you have performed a lumbar puncture on an infant, you’ll realize what I’m talking about.
The Vein of WhiteCoat runs along inner lumbar vertebrae of every child under 1 year of age. It is nearly impossible to miss the Vein of WhiteCoat when performing a lumbar puncture. You must first hit the Vein of WhiteCoat and allow a few drops of blood to escape through the spinal needle in order to decompress the Vein of WhiteCoat before you can obtain spinal fluid from an infant. It is just a rule of emergency medicine. Most of you docs out there probably didn’t know that I had dibs on that eponym, but now you have a completely logical explanation as to why nearly every spinal tap on an infant results in a few drops of whole blood from the needle before you reposition the needle and actually get spinal fluid. Go ahead and write it in the charts. A quick internet search will let everyone know what you’re talking about.
If you happen to get spinal fluid without decompressing the Vein of WhiteCoat first, then the child just has some anatomical abnormality. No worries. Carry on.
This patient’s spinal fluid looked good during the procedure. Of course the microscopic exam came back with 44 red cells.