Pain, Position, and Stylet Styles

Baxter, Amy L.; Welch, J. Camille; Burke, Bonnie L.; Isaacman, Daniel J.

doi:10.1097/01.pec.0000148030.99339.fe

Cited by 37 publications

(4 citation statements)

References 31 publications

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“…A large retrospective study of pediatric oncology patients cited black ethnicity, a younger patient age, a low platelet count, and a lower level of practitioner experience as risk factors for traumatic LP [ 35 ]. The use of local anesthetic and early removal of the spinal needle stylet have also been reported to increase success rates among infants under three months of age (12 weeks) [ 12 , 36 ]. In recent years, many studies in pediatric anesthesia and oncology have promoted the use of intravenous analgesia and anesthesia for a successful LP [ 37 , 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, many studies in pediatric anesthesia and oncology have promoted the use of intravenous analgesia and anesthesia for a successful LP [ 37 , 38 , 39 ]. Factors affecting the success of the procedure include the age of the patient, the experience of the clinician carrying out the procedure, the needle being advanced with the stylet in place, the type of stylet employed, the use of topical anesthesia, and the position in which the patient is placed [ 13 , 28 , 36 , 40 ]. Researchers are agreed that factors such as a patient’s age of less than one year, not using a local anesthetic, delayed stylet removal, and increased movements on the part of the patient can result in failed LP [ 9 , 13 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…Factors affecting the success of the procedure include the age of the patient, the experience of the clinician carrying out the procedure, the needle being advanced with the stylet in place, the type of stylet employed, the use of topical anesthesia, and the position in which the patient is placed [ 13 , 28 , 36 , 40 ]. Researchers are agreed that factors such as a patient’s age of less than one year, not using a local anesthetic, delayed stylet removal, and increased movements on the part of the patient can result in failed LP [ 9 , 13 , 36 ]. However, several studies indicate no association between the LP position and the level of training of the practicing clinician (physician or intern), the body weight of the infant, or corrected gestational age in preterm infants [ 3 , 28 , 41 , 42 ] In the present study, all patients were administered topical lidocaine and intravenous parasetamol before LP.…”

Section: Discussionmentioning

confidence: 99%

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Do Spinal Needle Sizes Affect the Development of Traumatic CSF in Neonatal LP Procedures?

Orman

Aydin

2023

Children

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Lumbar puncture (LP) is widely employed to evaluate infectious, neurological and metabolic diseases in the newborn. Neonatal LP is a difficult procedure with 45–54% success rates. Although there are studies examining traumatic LP failure, studies on the effects of needle sizes are limited. This study was intended to investigate the effect of needle sizes on LP traumatization. Term and premature babies who underwent LP in the neonatal intensive care unit between 30 November 2017 and 30 July 2019 were included in the study by retrospective file scanning. LP was performed by a pediatric or neonatal specialist using a 22 Gauge pen (G) or 25 G pen spinal needle in all cases, with all patients being placed in the lateral decubitus position. The primary outcome was to evaluate the effect of needle sizes used in LP on traumatization. The secondary outcome was to evaluate traumatization rates and complications. A statistically significant difference was determined in the rate of traumatized LP and desaturation development between needle sizes and CSF microscopic findings (p = 0.031, p = 0.005, and p = 0.006, respectively). The study data show that 25 G pen-tip spinal needles cause less traumatic LP in neonates than 22 G pen-tip spinal needles.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Do Spinal Needle Sizes Affect the Development of Traumatic CSF in Neonatal LP Procedures?

Orman

Aydin

2023

Children

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“…A total of 225 abstracts were screened. After further assessment of 22 full reports, 16 studies were excluded [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] and 6 studies included for systematic review and meta-analysis (Fig. 1) [15,[38][39][40][41][42].…”

Section: Searchmentioning

confidence: 99%

Lumbar puncture position in infants—a systematic review and meta-analysis

Kuitunen

Renko

2023

Eur J Pediatr

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To analyze the optimal lumbar puncture position in infants. A systematic review and meta-analysis. Infants (age < 1 year). December 2022 in PubMed, Scopus, and Web of Science. Randomized controlled trials focusing on lumbar puncture positions were included. Other lumbar puncture position than standard lateral decubitus position. First puncture success and overall success rate. Secondary outcome was desaturation during puncture and procedure-related harms. Risk of bias 2.0 assessment was performed. Outcomes are reported as risk ratios (RR) with 95% confidence intervals (CI). We screened 225 abstracts, and six studies were included. Four studies compared sitting position, one study head elevated lateral position, and one study prone position to lateral position. Risk of bias was high in two studies. First puncture success rate in sitting position (RR 1.00, CI: 0.78–1.18; 2 studies) and overall success rate in sitting position were similar to lateral position (RR 0.97, CI: 0.87–1.17; 3 studies). First attempt success rate was higher in elevated lateral position (RR 1.48, CI: 1.14–1.92; 1 study) and in prone position (RR 1.09, CI: 1.00–1.17; 1 study). Conclusion: Sitting position seems to be equally effective in terms of first attempt and overall success in lumbar puncture than standard lateral position. Elevated lateral position and prone positions had better first attempt success than standard lateral position, but these were assessed only in one study each and thus further studies in these positions are needed. Trial registration: This review was registered in PROSPERO. ID: CRD42022382953. What is Known:• Success rate in lumbar puncture has been poor and first attempt success rate has varied between 50 to 80% in literature.• Optimal lumbar puncture positions for infants have been debated between sitting and lateral decubitus position mostly. What is New:• This is the first meta-analysis focused on lumbar puncture positions in infants, and it found that sitting position was equal to standard lateral position.• Prone position and head elevated lateral positions had higher first puncture success rates, but these were assessed both only in one study, which creates uncertainty to the finding.

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Approach to Pain Management

Young¹

2008

Pediatric Emergency Medicine

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Pain, Position, and Stylet Styles

Abstract: Analgesia is underused for infant LPs. Advancing the needle without a stylet is not uncommon. Response rate to regular mail surveys was much higher.

Cited by 37 publications

References 31 publications

Do Spinal Needle Sizes Affect the Development of Traumatic CSF in Neonatal LP Procedures?

Do Spinal Needle Sizes Affect the Development of Traumatic CSF in Neonatal LP Procedures?

Lumbar puncture position in infants—a systematic review and meta-analysis

Approach to Pain Management

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