Atraumatic needles for lumbar puncture: why haven't neurologists changed?

  title={Atraumatic needles for lumbar puncture: why haven't neurologists changed?},
  author={Angharad Davis and Ruth Dobson and Stefania Kaninia and Gavin Giovannoni and Klaus Schmierer},
  journal={Practical Neurology},
  pages={18 - 22}
Diagnostic lumbar puncture is a key procedure in neurology; however, it is commonly complicated by post-lumbar puncture headache. Atraumatic needle systems can dramatically reduce the incidence of this iatrogenic complication. However, only a minority of neurologists use such needles. In this paper, we discuss possible reasons why neurologists have not switched to new technology, looking more at diffusion of innovation rather than lack of evidence. We suggest ways to overcome this failure to… 

Atraumatic (pencil-point) versus conventional needles for lumbar puncture: a clinical practice guideline

The BMJ Rapid Recommendations panel makes a strong recommendation for the use of atraumatic needles for lumbar puncture in all patients regardless of age (adults and children) or indication instead of conventional needles.

CSF examination still has value in the diagnosis of MS—YES

Lumbar puncture is a procedure first described by August Bier and Heinrich Quincke in 1891 as a diagnostic method for increased intracranial pressure and reported the first classical description of post-dural puncture headache (PDPH).

A nudge towards better lumbar puncture practice.

Changing defaults may be an effective, inexpensive and acceptable intervention to improve lumbar puncture practice and is reviewed in the context of wider literature on the power of default options in driving behavioural choices.

Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis

Atraumatic needles were associated with a decrease in the incidence of postdural-puncture headache and in the need for patients to return to hospital for additional therapy, and had similar efficacy to conventional needles.

Straight to the point: an updated technique for performing lumbar puncture safely in obese patients

Performing lumbar puncture in obese patients using this updated technique using an introducer is a safe, successful and cost-effective technique.

Occurrence of postdural puncture headache—A randomized controlled trial comparing 22G Sprotte and Quincke

To assess the incidence of postdural puncture headache (PDPH) using 22‐gauge atraumatic needle (Sprotte, 22GS) compared with 22‐gauge traumatic needle (Quincke, 22GQ).

CSF examination still has value in the diagnosis of MS – NO

The aim of this research is to develop treatments, to monitor treatments, and also to try to reveal the causes and pathophysiology underlying serious diseases.



Atraumatic Lumbar Puncture Needles: After All These Years, Are We Still Missing the Point?

The use of atraumatic spinal needles for lumbar puncture has been shown to significantly reduce the incidence of postdural puncture headache compared with cutting needles, without loss of efficacy or ease of use.

Change practice now! Using atraumatic needles to prevent post lumbar puncture headache

Evidence suggests that using atraumatic needles for diagnostic LP (ATNLP) reduces risk of Post lumbar puncture headache (PLPHA), but clinicians in Europe and the USA routinely use traumatic needles fordiagnostic LP (TNLP).

Standard vs atraumatic Whitacre needle for diagnostic lumbar puncture: A randomized trial

In order to define the impact of needle type on post-lumbar puncture headache (PLPH), a prospective, randomized trial comparing the incidence of PLPH in patients undergoing LPs with traumatic vs atraumatic 22-gauge needles was performed.

“Atraumatic” Sprotte needle reduces the incidence of post-lumbar puncture headaches

Post-lumbar puncture headache (PLPH) is best explained by spinal fluid leakage due to delayed closure of a dural defect, and use of the “atraumatic” Sprotte needle for lumbary puncture is recommended.

Traumatic vs. atraumatic 22 G needle for therapeutic and diagnostic lumbar puncture in the hematologic patient: a prospective clinical trial.

This study prospectively compared traumatic (TN) vs. atraumatic 22G needles in hematologic patients undergoing LP to investigate the impact of needle type on post lumbar puncture headache (PLPH).

Are atraumatic spinal needles as efficient as traumatic needles for lumbar puncture?

Average flow rates and duration of pressure measurements are comparable between atraumatic spinal needles and traumatic needles, and these performance characteristics are no reason to favor traumatic needles over atRAumatic needles.

Introduction of Sprotte needles to a single-centre acute neurology service: before and after study

The implementation of atraumatic needles in an acute neurology service is safe and produces reliable, reproducible results in keeping with previously published randomized controlled trials.

Education Research: Changing practice

Background: The atraumatic needle is recommended over the cutting needle to prevent complications related to lumbar puncture and to reduce costs to the health care system. However, very few

Education Research: Changing practice: Residents' adoption of the atraumatic lumbar puncture needle

I applaud Dr. Tung's1 efforts in attempting to change her residents' practice with the goal of preventing postdural puncture headache (PDPH). Despite scientific evidence and institutional