First published research demonstrates safety and effectiveness of seated positioning for ultrasound-guided procedures
When Children’s Hospital of Los Angeles implemented the Smoltap® infant positioning device in their interventional radiology department, they didn’t just change their procedure protocol—they revolutionized their entire approach to infant lumbar punctures. Now, the first peer-reviewed study on the device, published in Pediatric Radiology, validates what early adopters have been experiencing: safer, more efficient procedures without the need for sedation.
The Problem: Traditional Infant LPs Fall Short
The challenge facing pediatric medical teams is stark. Approximately 40% of bedside infant lumbar punctures fail, requiring repeat attempts with image guidance. Traditional image-guided procedures require infants to be either sedated by an anesthesiologist or manually restrained in lateral position—consuming significant resources and creating potential safety concerns.
Dr. Shimwoo Lee and Dr. Joseph Miller from Children’s Hospital of Los Angeles recognized this inefficiency and became early adopters of the Smoltap device. Their retrospective analysis comparing 42 procedures with Smoltap versus 37 traditional procedures reveals compelling advantages that directly address the pain points facing pediatric departments today.
Download the full article (pdf) here >>>
Game-Changing Results: What the Numbers Tell Us
93% Success Rate with Zero Sedation
The study’s most striking finding: 93% of procedures using Smoltap successfully obtained adequate CSF for microbial culture, with 100% of infants remaining awake throughout the procedure. This eliminates the need for anesthesiologist involvement, freeing up critical resources for other cases.
Comparable Safety and Efficiency
- Zero complications in both device and traditional groups
- Similar procedure duration (14 minutes vs 16 minutes)
- 100% diagnostic adequacy for microbial culture testing
Resource Liberation
Prior to Smoltap implementation, over 75% of infant LPs required anesthesia. Post-implementation, the team could perform procedures without anesthesia on most eligible infants, significantly reducing resource burden and scheduling constraints.
Why Seated Position Changes Everything
The study reinforces what previous research has shown about the anatomical advantages of seated positioning:
- Increased interspinous process distance for easier needle access
- Larger subarachnoid space improving success rates
- Reduced risk of desaturation compared to lateral positioning
- Better respiratory mechanics without chest compression
The Smoltap device makes these benefits accessible in a controlled, reproducible way—without requiring staff to manually restrain infants throughout the procedure.
Download the full article (pdf) here >>>
Real-World Impact: What This Means for Your Department
Immediate Operational Benefits
- Reduced anesthesia dependency: Eliminate scheduling bottlenecks and resource conflicts
- Improved staff experience: No more manual restraint requirements for support staff
- Enhanced safety profile: Avoid sedation-related risks in vulnerable infant populations
- Radiation elimination: Ultrasound-only guidance removes fluoroscopy exposure
Patient and Family Benefits
- Awake procedures: Families can comfort their infants throughout the process
- Faster recovery: No post-sedation monitoring requirements
- Reduced procedural stress: Stable, comfortable positioning for the infant
Quality Improvement Opportunities
- Standardized positioning: Reproducible setup regardless of staff experience level
- Training efficiency: Simplified procedure protocol for new team members
- Outcome consistency: Reliable positioning eliminates technique variability
Study Limitations and Future Directions
The researchers acknowledge this retrospective analysis used historical controls, creating some heterogeneity in comparison groups. However, the dramatic shift in practice patterns—from 75% sedated procedures to predominantly awake procedures—speaks to the device’s practical effectiveness in real-world settings.
The study suggests a weight guideline of 5-5.5 kg as a practical upper limit, complementing the manufacturer’s length specification of <57 cm head-to-toe.
The Bottom Line: Evidence-Based Innovation
This study provides the peer-reviewed validation that evidence-based medical professionals demand. The Smoltap device doesn’t just offer theoretical advantages—it delivers measurable improvements in:
- Resource utilization
- Procedural safety
- Staff workflow
- Patient experience
As Dr. Lee concludes: “Performing image-guided infant LPs with a positioning device is a feasible and safe alternative to the conventional technique with the benefit of not needing to sedate or manually hold infants.”
Ready to transform your infant LP procedures? Contact our clinical team to discuss implementation strategies, training protocols, and how Smoltap can address your department’s specific challenges. With growing evidence base and proven real-world results, the question isn’t whether seated positioning works—it’s whether you can afford to continue with conventional approaches.
The full study “Use of seated positioning device (Smoltap®) for ultrasound-guided infant lumbar punctures” is published in Pediatric Radiology (2025). You may download the study (PDF) here.