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THUR 264 Multimodal intervention to improve lumbar puncture
  1. Tobert Vanessa,
  2. Allen James,
  3. Edmond Evan
  1. Oxford University Hospitals NHS Foundation Trust


Introduction Lumbar puncture (LP) is a routine procedure performed for diagnostic and therapeutic indications for more than 120 years.1 For as long, post-dural puncture headache (PDPH) has been a complication that can be persistent and severe.2 Finer gauge needles and ‘atraumatic’ needle designs3 significantly reduce the incidence of PDPH.4–6

Methods A multimodal intervention consisting of teaching session on atraumatic needle usage, simulation training with 25G Sprotte needles, and electronic LP proforma was introduced in October 2017.

Records for all patients having LP in the Neurology day-case unit at the John Radcliffe Hospital, Oxford, in the months of November 2016 and Nov/Dec 2017 were retrospectively reviewed for documentation and atraumatic needle usage.

Results 39 records were reviewed from Nov/Dec 2017 and 16 from November 2016. Documentation was significantly improved across all criteria assessed except for documentation of informed consent. Atraumatic needle usage increased from none documented pre-intervention to 38% (n=11 out of 29 where atraumatic needle indicated) post intervention.

Conclusion Proforma use was associated with improved LP documentation. Atraumatic needle usage increased significantly post-intervention. These results are consistent with previous studies on changing behaviour in LP technique in neurology.7 Large scope for further improvement exists.

References 1. Quincke H. Die Lumbalpunction des Hydrocephalus -Heinrich Quincke -Google Books 1891. Klin. Wochenschrist. pp. 929–965.

2. Greene HM. Lumbar puncture and the prevention of postpuncture headache. JAMA J. Am. Med. Assoc 1926;86:391.

3. Hart JR, Whitacre RJ. Pencil-point needle in prevention of postspinal headache. J. Am. Med. Assoc 1951;147:657.

4. Vallejo MC, Mandell GL, Sabo DP, Ramanathan S. Postdural puncture headache: A randomized comparison of five spinal needles in obstetric patients. Anesth. Analg 2000;91:916–20.

5. Thomas SR, Jamieson DR, Muir KW. Randomised controlled trial of atraumatic versus standard needles for diagnostic lumbar puncture. BMJ 2000;321:986–90.

6. Halpern S, Preston R. Postdural puncture headache and spinal needle design. Metaanalyses. Anesthesiology 1994;81:1376–83.

7. Davis A, et al. Change practice now! Using atraumatic needles to prevent post lumbar puncture headache. Eur. J. Neurol 2014;21:305–11.

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