Background In 2005 the American Academy of Neurology (AAN) recommended the use of atraumatic needles to prevent post lumbar puncture headache (PLPHA) on patients undergoing diagnostic LPs.

Objectives To determine if Craigavon Hospital is compliant with new guidelines introduced in June 2009 based on the recommendations made by the AAN.

Methods An audit was conducted comparing atraumatic needle usage pre and post guideline implementation. Additional data were analysed regarding the occurrence, timing and severity of the headaches. The number of LP attempts was also reviewed. A total of 29 patients underwent diagnostic LP's between 19 December 2008 and 14 January 2010. Data were collected via patient questionnaires and review of medical notes.

Results Post guideline introduction atraumatic needle usage increased from 6.7% to 57.1%. PLPHA rate reduced from 46.6% to 21.4%. Fifty percent of patients that developed headache found it more severe than they expected. The more attempts needed for successful lumbar puncture, the higher the risk of PLPHA (18.6% with one attempt increasing to 100% for four attempts).

Conclusion Following introduction of the AAN guidelines atraumatic needle use for diagnositic LP's increased and the incidence of PLPHA reduced. Currently 43.9% of LP procedures are not compliant with the current guidelines.