Increasing Success with Infant Spinal Taps

I think infant lumbar punctures are actually easier than spinal taps on older children and adults. Unfortunately, success, as measured by acquiring sparkling clear (nontraumatic) spinal fluid, is sometimes elusive. Twenty to thirty percent of spinal taps in the training setting, in fact, can be traumatic or unsuccessful. (Pediatr Emerg Care 2010;26[7]:487.) Three easy steps, however, can increase one’s odds for success.   Use Local AnesthesiaThe evidence shows that the success rate is improved when injected or topical anesthesia is used, but this practice is commonly ignored by practitioners. The literature clearly supports using local anesthesia. An article by Pinheiro et al demonstrated a reduction in the infant's "struggling motion score" after lidocaine was applied. (Pediatrics 1993;91[2]:379.) The number of traumatic taps, rate of failure, and number of attempts in that study were not reduced, but subsequent studies have indicated otherwise.   A 2006 study by Baxter et al showed that not using local anesthetic was more commonly associated with traumatic or unsuccessful lumbar punctures. (Pediatrics 2006;117[3]:876.) Another study by Nigrovic et al revealed that not using local anesthetic was associated more often with failure. (Ann Emerg Med 2007;49[6]:762.) Two modifiable factors — anesthetic use and stylet removal — influenced the rate of success in that study.   A majority of clinicians believe otherwise, for some unclear reason. A study by Quinn et...
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