Analysis of Infant Lumbar Puncture Success Rates: Sitting Flexed Versus Lateral Flexed Positions

@article{Hanson2014AnalysisOI,
  title={Analysis of Infant Lumbar Puncture Success Rates: Sitting Flexed Versus Lateral Flexed Positions},
  author={Amy L Hanson and Simon P. Ros and Joyce V. Soprano},
  journal={Pediatric Emergency Care},
  year={2014},
  volume={30},
  pages={311–314}
}
Objectives The primary objective was to determine whether the sitting flexed position yields higher success rates of obtaining cerebrospinal fluid (CSF) for culture. The secondary objectives were to determine whether the sitting flexed position yields higher success rates of obtaining the following: CSF for cell count, non–traumatic CSF, and CSF on the first attempt. Methods The study investigator performed a retrospective chart review of infants 0 to 365 days of age who had a lumbar puncture… 
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QUESTION 2: Is the lateral decubitus position best for successful paediatric lumbar puncture?
You are a paediatric registrar who is called by the emergency department to assess a febrile 13-month-old infant. On clinical review of the infant, you feel a lumbar puncture (LP) is indicated and
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TLDR
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TLDR
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TLDR
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References

SHOWING 1-10 OF 20 REFERENCES
Sitting or Tilt Position for Infant Lumbar Puncture Does Not Increase Ultrasound Measurements of Lumbar Subarachnoid Space Width
TLDR
The subarachnoid space width did not significantly change between the 3 positions, and an increase in lumbar puncture success rate with sitting or tilt position could be due to other factors such as increased cerebrospinal fluid pressure, increased interspinous space widening, or improved identification of landmarks.
Lidocaine for lumbar punctures. A help not a hindrance.
TLDR
Premedication with lidocaine for an LP does not binder the ease of obtaining CSF and this finding is negated when traumatic is defined as more than 10,000 x 10(6)/L CSF red blood cells.
Optimal patient position for lumbar puncture, measured by ultrasonography
TLDR
The results showed that the interspinous distance was significantly greater in the “sitting, feet supported” position than in the other two positions (P<0.001), which may offer advantages for selected patients undergoing lumbar puncture.
Local Anesthetic and Stylet Styles: Factors Associated With Resident Lumbar Puncture Success
TLDR
Pat age, use of local anesthetic, and trainee stylet techniques were associated with LP success rates, and should be considered in the training of physicians to maximize their success with this important procedure.
The effect of lumbar puncture position in sick neonates.
TLDR
Increased intraesophageal pressure, in the standard lateral position, suggests extrathoracic compression of the chest by the abdominal contents in sick neonates, and recommends lumbar punctures be done in the sitting or modified lateral position.
Optimal position for a spinal tap in preterm infants.
TLDR
The data suggest that although hypoventilation may contribute to the observed decrease in transcutaneous PO2, ventilation/perfusion imbalance appears to be the major mechanism.
Positioning of infants in the neonatal intensive care unit for lumbar puncture as determined by bedside ultrasonography
TLDR
Sitting flexed position, which seems to be sufficiently safe and serve to enhance the success rate of a LP, should be favoured for sick neonates whenever the infant's condition permit a spinal tap.
Pain, Position, and Stylet Styles: Infant Lumbar Puncture Practices of Pediatric Emergency Attending Physicians
TLDR
Analgesia is underused for infant LPs, and almost a third will advance the needle without the stylet in place, and response rate to regular mail surveys was much higher.
Role of local anesthesia during lumbar puncture in neonates.
TLDR
It is concluded that local anesthesia with lidocaine decreases the degree of struggling but does not alter the success rate of lumbar puncture in neonates, and the practice of withholding lidocane anesthesia from neonates undergoing lumbr punctures cannot be justified by arguing that it makes the procedure more difficult to perform.
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