We never ever do LPs. If they can't get done by the ER doc or whoever else might be doing it, they go to IR.
This.
Doing spinals under fluoroscopy is extremely easy. I inject the die for myelograms all the time. A lot of IR docs don’t like doing these either btw because they don’t want to manage blood patches should they occur.
OP-
keep in mind that you’ll be responsible for epidural blood patches as well if they come back with a spinal headache. And if you offer to help with spinals, you’re getting invited to endless consults on “evaluate for spinal headache” along with need to obtain csf for meningitis workup etc.
At that point the ER will call you and you’ll now be doing a blood patch on a patient that had a difficult spinal where you’re not sure of anatomy.
Also you have no clue who did the original spinal and how it was done. No one accurately documents how many attempts were made.
I don’t care much about spinals technically.
They’re personally very easy for me as I always do them paramedian approach where I just isolate one side and aim from left to right. I’m right handed so for me I go left to right paramedian. That’s my natural angle.
Avoid the spinous process. Hit the lamina. Advance up or down since I have the side already isolated.
I also bend the tip of my spinal needle like a hockey stick - this allows you another axis of rotation to get off the bone to enter LF and then pierce dura. Again that’s just a modification based on my training as a pain doc.
I’m however more concerned about potential for EBP and how difficult some of those can be and you’re blindly putting a tuohy needle with an ongoing CSF leak.
Anatomically, this happens because ligamentum flavum can be variable in certain areas - more so in cervical spine vs lumbar but it can happen. Even under fluoro I never feel the loss yet I’m in the epidural space based on lateral and after injecting contrast voila I’m in the epidural space. It’s quite remarkable how often that happens actually.
Given what you’re describing, I’d just decline. Even if you agree I don’t think many of your partners would want this responsibility.
And yes of course the hospital would like to pawn off this to someone else besides ER. Because no one wants to do these procedures. ER doesn’t either. Hospital wants them done because they make facility fee. IR would be the next best and safest choice IMO.