Reinsertion of the stylet before needle removal in diagnostic lumbar puncture

Deibel, M.; Jones, J. W.; Brown, Michael D.

doi:10.1136/emj.2004.021188

Cited by 6 publications

(2 citation statements)

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“…Reinsertion of a stylet before needle withdrawal may facilitate dural closure by reinserting arachnoid particles into the dura, resulting in decreased CSF leakage [29,30]. The patient’s position during LP and the duration of recumbence following LP did not influence the occurrence of headache [21], whereas, in contrast to widespread belief, immediate mobilization seems to be preferable after LP, as described in 2 randomized controlled trials comparing a 4- and 6-hour bed rest with immediate mobilization.…”

Section: Factors Affecting Plphmentioning

confidence: 99%

Lumbar Puncture: It Is Time to Change the Needle

2010

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Lumbar puncture is a frequent procedure performed by physicians from several disciplines to help establish a diagnosis and treatment for several diseases. Post-lumbar puncture headache (PLPH) is a frequent complication that typically lasts for a couple of days and can be severe enough to immobilize the patient and to require therapy. There are several risk factors identified, pain characteristics, and characteristic findings on spinal and head magnetic resonance imaging. There are several procedural factors that have been identified to be of consequence in attenuating the PLPH incidence, specifically the needle type and size used for this procedure. Once PLPH occurs, the clinician should treat it conservatively with bed rest, analgesics and increased fluids intake, especially caffeine-containing beverages, as it can dramatically affect the patient’s wellness. If the pain is severe and disabling and does not respond to conservative treatment, a blood patch should be considered at least 24–48 h following the LP. Epidural blood patch is a safe and rapidly effective treatment in experienced hands. Furthermore, patients who developed PLPH should be advised to contact the medical staff in case of changes in the characteristics of headaches. When a patient who was diagnosed with PLPH has a change in the pain character, or additional neurological manifestations appear, an urgent brain CT/head MRI should be performed to exclude rarer life-threatening intracranial complications.

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Section: Factors Affecting Plphmentioning

confidence: 99%

Lumbar Puncture: It Is Time to Change the Needle

2010

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“…Topical anesthetics reduce needle pain, [10][11][12][13][14] but cost patients between $20 and $50 in the United States per use. In addition, they require prolonged application time 15 and can cause vasoconstriction.…”

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confidence: 99%