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Techniques and Procedures| Volume 64, ISSUE 3, P400-404, March 2023

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The “Syringe Hickey”: An Alternative Skin Marking Method for Lumbar Puncture

  • Emmanuelle C. Issa
    Correspondence
    Reprint Address: Emmanuelle C. Issa, Laboratory for Innovations in Medical Education (LIME), Loma Linda University School of Medicine, 11175 Campus St., Loma Linda, CA 92350
    Affiliations
    Laboratory for Innovations in Medical Education (LIME), Loma Linda University School of Medicine, Loma Linda, California
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  • Peyton J. Ware
    Affiliations
    Laboratory for Innovations in Medical Education (LIME), Loma Linda University School of Medicine, Loma Linda, California
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  • Paula Bitange
    Affiliations
    Laboratory for Innovations in Medical Education (LIME), Loma Linda University School of Medicine, Loma Linda, California
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  • Garrett J. Cooper
    Affiliations
    Laboratory for Innovations in Medical Education (LIME), Loma Linda University School of Medicine, Loma Linda, California
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  • Tori Galea
    Affiliations
    Laboratory for Innovations in Medical Education (LIME), Loma Linda University School of Medicine, Loma Linda, California

    Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, California
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  • Deena I. Bengiamin
    Affiliations
    Laboratory for Innovations in Medical Education (LIME), Loma Linda University School of Medicine, Loma Linda, California

    Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, California
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  • Timothy P. Young
    Affiliations
    Laboratory for Innovations in Medical Education (LIME), Loma Linda University School of Medicine, Loma Linda, California

    Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, California
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      Abstract

      Background

      Lumbar puncture is a procedure that is commonly performed in emergency departments. Despite their absence from procedure kits, emergency physicians often use skin markers to delineate landmarks for a lumbar puncture. We prefer to create a temporary indentation in the skin using the suction of a syringe. This “syringe hickey” eliminates the need for a skin marker.

      Discussion

      We created a photo demonstration comparing the syringe hickey to a skin marker for site marking. The syringe hickey was created using a 10-mL syringe aspirated to 5 mL on the forearm for 1 min. The syringe hickey lasted over 30 min on a range of skin tones across the Fitzpatrick Scale. The skin marker faded but the syringe hickey maintained its definition after application of ultrasound gel and sterilization with either chlorhexidine or betadine.

      Conclusions

      The syringe hickey is a simple skin marking technique that is resistant to antiseptic agents and ultrasound gel. The syringe hickey may be useful for other procedures that require puncture site marking.

      Keywords

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