Brian Alverson, MD, had been performing spinal taps in babies for over 20 years. One day he had enough. “I had just finished another difficult spinal tap requiring multiple attempts, and I wished there was a better way,” he said. The procedure often requires contorting the baby in a difficult position and squeezing them tightly while simultaneously making a puncture in the spine. “This is very painful for the infant and because infants can squirm, it makes it very hard to get the sample,” said Alverson, pediatric program director and vice-chair of education at Nemours Children’s Hospital, Delaware in Wilmington. There is about a 25% failure rate for infants undergoing spinal taps.
What need does the Smoltap device meet?
The device places the child in an upright sitting position. Ultrasound data has demonstrated that the spinal column is wider when infants are sitting up. Therefore, you are more likely to hit the target and get the spinal fluid you're looking for. After about seven or eight rounds of redesign we figured out a couple other ways to make the child more comfortable as well. We improved the padding, and the location of the hole for the child's face allows for easy administration of sugar water. In infants, sugar water is as effective as morphine in reducing pain. And because the infant is in an upright comfortable position and well-controlled in terms of positioning, we are now able to significantly increase the likelihood of a successful lumbar puncture.
How did you end up leading the development of a medical device?
I was walking down the hall of the hospital and had just done a fairly difficult spinal tap on a baby requiring multiple attempts. My friend Ravi D’Cruz was teaching a device design class at Brown University and asked me if I had any ideas for a device. I replied, 'Boy, a device that holds a baby still during a spinal tap would be a really great thing,” and we immediately realized we had a great idea. Both of us got together and over four years developed Smoltap.
Why is this device beneficial to babies?
I have probably tapped about 50 infants in this device. I don't do as many spinal taps as an ER doctor because I'm a pediatric hospitalist. That said, I have never missed a tap on a first attempt using this device. That is vastly better than my experience holding babies in the lateral decubitus position. Also, I've been very successful at teaching the procedure to new trainees. I'm a pediatric residency director and frequently on the wards with young people who don't yet know how to do spinal taps. Every single time I have had a student or intern, they have successfully accomplished the tap using this device.
What differences have you seen since implementing the device?
There was an article that estimated a bloody spinal tap ends up costing the hospital over $2,000. It's older data, and we've probably revised how we manage kids a little bit since then, but there is no doubt that a clean tap makes things a lot easier for everybody. Babies are having shorter length of stay, residents and students are feeling more successful at the procedure, and I have more time to work on other things than trying over and over to get a spinal tap. Parents love it because it is much faster and less traumatic and painful for the baby. It's really a win for everybody.
