Atraumatic Lumbar Puncture

[Francesco Cardona]

Anyone have experience with atraumatic lumbar puncture?

Does anyone know if there is a needle available for puncture in neonates?

After reading this I am very curious:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32451-0/fulltext

[Stefan Johansson]

We are mainly using regular needles (used for sc injections), a "blue" needle that is 23G (0.6 x 30 mm).

Don't know if this truly makes sense, but we teach to direct the "eye" of the needle in 90 degrees angle to the back of the infant, to cut the dural fibers as little as possible.

We recently got an atraumatic needle on our shelfes though, but have not had the chance to test it myself - but will post a picture of it in after the Future of Neonatal Care  

(in case someone misunderstands the "Future...", after the Vienna meeting next week)

 

[RasmusR]

14 hours ago, Stefan Johansson said:

We are mainly using regular needles (used for sc injections), a "blue" needle that is 23G (0.6 x 30 mm).

Don't know if this truly makes sense, but we teach to direct the "eye" of the needle in 90 degrees angle to the back of the infant, to cut the dural fibers as little as possible.

We recently got an atraumatic needle on our shelfes though, but have not had the chance to test it myself - but will post a picture of it in after the Future of Neonatal Care  

(in case someone misunderstands the "Future...", after the Vienna meeting next week)

 

Which company produce the atraumatic needles for neonates?

I prepared a simulation course for neonatal LP puncture, and read a lot of literature on the subject then - at that point there wasn’t much evidence regarding atraumatic needles in neonates. The study would also be a bit harder to do than adults - as they can’t report pain/headache, the endpoint would probably have to be differences in eg. ComfortNEO score - but I guess it’s a question about when.

Stefan, you say that you use SC needles - do these have a stylet? I’ve always learnt you should avoid needles without stylets, as there’s a (small) risk of introducing an epidermoid tumor.

Furthermore there is quite good evidence that using early stylet removal will increase the chance of a clean LP. 

[Stefan Johansson]

@RasmusR In fact those needles do not have a stylet   that's why we are shifting to a stylet-equipped atraumatic needle. Will post a photo once I get back on clinical service!

 

[Stefan Johansson]

This is our new needle, a sharp 22G needle with stylet, 38 mm long (Vygon product but guess there are several suppliers).

 

[bimalc]

We use the same product Stefan posted

[RasmusR]

On 19/4/2018 at 9:59 AM, Stefan Johansson said:

This is our new needle, a sharp 22G needle with stylet, 38 mm long (Vygon product but guess there are several suppliers).

 

Thanks for the picture - it's difficult to see the bevel on the pictures, but from the label it seems like it's a "traumatic" needle (Quincke bevel) - if it was atraumatic, shouldn't it be a pencil-point type (eg. Whitacre/Sprotte)?

[bimalc]

On 4/23/2018 at 3:43 AM, RasmusR said:

it seems like it's a "traumatic" needle (Quincke bevel)

It is a Quincke (assuming I was correct in my assessment that this is the same needle I've used my entire professional career).