Changing the needle for lumbar punctures

Highlights

• Smaller, atraumatic needles reduce the incidence of post dural puncture headache (PDPH).

• These are still not routinely used in most neurology departments.

• We recorded PDPH rate, practical usability, and socioeconomic costs depending on needle choice.

• Using a smaller, atraumatic needle led to a reduced incidence of PDPH.

• Additionally, a substantial reduction in overall costs, and a higher success rate was observed.

Abstract

Objective

Post-dural puncture headache (PDPH) is a common complication of diagnostic lumbar punctures. Both a non-cutting needle design and the use of smaller size needles have been shown to greatly reduce the risk of PDPH. Nevertheless, larger cutting needles are still widely used. This study describes the process of changing the needle in an outpatient clinic of a Danish neurology department.

Methods

Prospective interventional trial. Phase 1: 22 G cutting needle. Phase 2: 25 G non-cutting needle. Practical usability of each needle was recorded during the procedure, while the rate of PDPH and the occurrence of socioeconomic complications were acquired from a standardized questionnaire.

Results

651 patients scheduled for diagnostic lumbar punctures were screened for participation and 501 patients were included. The response rate was 80% in both phases.

In phase 2, significant reductions were observed in occurrence of PDPH (21 vs 50, p = 0.001), number of days spent away from work (55 vs 175, p < 0.001), hospitalizations (2 vs 17, p < 0.001), and number of bloodpatch treatments (2 vs 10, p = 0.019). Furthermore, during the procedure, both the need for multiple attempts (30% vs 44%, p = 0.001), and the failure-rate of the first operator (17% vs 29%, p = 0.005) were reduced.

Conclusions

Our study showed that smaller, non-cutting needles reduce the incidence of PDPH and are easily implemented in an outpatient clinic. Changing the needle resulted in fewer socioeconomic complications and fewer overall costs, while also reducing procedural difficulty.