G134(P) Lumbar Punctures in Children: A Survey of Current Practise

Abstract

Aims Lumbar puncture (LP) is a common procedure in children used to diagnose infection and various neurologic processes. We want to survey current clinical practises, in terms of positioning and use of analgesia, in paediatric LPs. Methods A survey questionnaire was designed for distribution to staff on the wards of 10 paediatric departments in one city. The survey contained questions about demographics, choice of position during LPs, reasons for that choice, use and frequency of analgesia, LP training background and demand for training. Questions about positions and pain relief were divided into different age groups. Results A total of 84 questionnaires were completed, which demonstrated that the most common position being used in children under the age of 1 was the lateral recumbent position with neck flexion (83% in newborns to 3 months and 59% in 3 months to 1 year). 61% of participants said this position was used to increase the interspinous distance, whilst 27% said is was used to best hold the child still. Sucrose was the most commonly used for of pain relief in children under one, however 39% of participants never, rarely or only sometimes used pain relief in this age group. 79% of participants would appreciate more training in this area. Conclusion We demonstrated that a painful, uncomfortable and potentially dangerous position to hold children during LPs was the first choice in the majority of cases. We also demonstrated that the use of analgesia in general was either absent or poor. Further education of healthcare staff involved in this procedure is needed.

QUESTION 2: Is the lateral decubitus position best for successful paediatric lumbar puncture?

“…However, as with many procedures, there are different approaches to LP and one variable is the position in which a child is placed. The most commonly used position for paediatric LP is the lateral decubitus position or a variant of this 11 12. Paediatric LP can be performed in a variety of positions and evaluating which is optimal can be challenging.…”