u/sqic80

How do you all go about sorting through these types of invitations? Some are for journals I know/read or are on a topic I have no business reviewing/editing, but I frequently get invites from journals that are unfamiliar to me, and the journal seems legit or the topic is of interest.

Impact factor? Identity/reputation of the editorial board? Just do whatever you have time for and have the appropriate knowledge for? I don’t have capacity to do everything I’m sent, but I also don’t want to just pick things at random…

I am a very proficient proceduralist in my 2 procedures - LPs and bone marrow biopsies. I am well known by OR staff to be skilled and efficient, and colleagues will call me if they are struggling. I typically go straight in, feel the pop, and get the fluid. A med student once gasped watching me do an LP. I perform these procedures across the lifespan - neonate to adult.

BUT… like 2-3 times a year, out of probably close to a hundred procedures, I struggle with an LP. It’s now been enough times that I can identify the commonality - typically mid-to-late adolescent young women.

I am NOT someone who is good with spatial reasoning. When I struggle, I troubleshoot systematically:

- patient positioned well - shoulder, hips, knees stacked, as tucked as possible (we do them all left lat decub)

- needle length appropriate

- angle of entry appropriate (toward head)

- triple check landmarks

- ask anesthesia to watch to make sure I’m not missing something - never have they ever been able to identify some obvious failure of my technique or positioning

The issue I (literally) run into is that I am able to advance the needle so far and then hit bone. I am always able to get it eventually, mostly because I am comfortable just adjusting and trying a different spot/angle, and I am told that my “struggle” is still half the time of most people’s “success”, but it’s really frustrating and affects my confidence, which affects my success.

It’s not every adolescent female I struggle with, and I have done back to back LPs on the same adolescent female patient and struggled once and then got it the first try on the next one.

Anyone with better understanding of skeletal development and anatomy of an LP able to clearly see and explain what might be going awry in these cases and how I could troubleshoot preemptively or just more effectively?