Risk factors for unsuccessful lumbar puncture in children

Abstract

Unsuccessful LP was common. Sedation was not routinely used, but the results suggest that it may be associated with a reduction in the rate of unsuccessful LP. Unsuccessful LP may lead to diagnostic uncertainty, prolonged hospitalisation and unnecessary antibiotic use. Whether a procedural sedation protocol would reduce the rate of unsuccessful LP requires further study.

Medication Use in the Diagnostic Pediatric Lumbar Puncture

“…The positive association between sedation use and successful LP is consistent with Procter et al, who revealed that sedation with predominantly ketamine was associated with reduction in the rate of unsuccessful LP. 14 Howard et al also demonstrated this finding in LPs for patients with leukemia, although indirectly, given that most patients were under conscious sedation. 19 Our results further evaluated and validated the efficacy and safety of ketamine and propofol as moderate to deep sedatives.…”

“…Apart from established factors such as young age, stylet practices, and provider experience that have been associated with unsuccessful LPs, our study further establishes that patients who are overweight are more likely to have an unsuccessful LP outcome. 14,25 Overweight patients likely have more subcutaneous tissue overlying the LP site, making for a more difficult LP. However, we also noted that the rate of unsuccessful attempts was similar, but not statistically significant, in underweight patients as well.…”

“…Outcomes were defined as unsuccessful attempts if the record had a subjective description of an unsuccessful attempt, the need of multiple attempts within 24 hours, or bloody, uninterpretable cerebrospinal fluid (CSF). Bloody CSF was defined objectively as CSF where the red blood cell (RBC) count is higher than 400 cells/µL, the visual threshold for blood in the CSF, or if CSF appearance was reported as “serosanguineous,” “pink,” or “bloody.” 14 Of note, the threshold of 400 RBC/µL is not a comment on the overall utility of the CSF obtained, rather the overall procedure itself, thus deemed an unsuccessful attempt.…”

“…Bloody CSF was defined objectively as CSF where the red blood cell (RBC) count is higher than 400 cells/µL, the visual threshold for blood in the CSF, or if CSF appearance was reported as "serosanguineous," "pink," or "bloody." 14 Of note, the threshold of 400 RBC/µL is not a comment on the overall utility of the CSF obtained, rather the overall procedure itself, thus deemed an unsuccessful attempt.…”

Ultrasound‐guided “saline myelogram”: Confirmation of intrathecal drug delivery despite “dry tap” in infants for spinal anesthesia and spinal therapeutics

“…Previous case series on diagnostic lumbar punctures and spinal anesthetics in infants document comparatively high rates of traumatic or unsuccessful procedures; the latter is known as a "dry tap." 1 Several studies have reported a first pass success rate of only around 60% . 2 The thecal sac in quite narrow in-term and preterm newborns.…”