Lumbar Puncture Needles in Pediatric Medicine
Lumbar Puncture Needles in Pediatric Medicine
Lumbar puncture (LP) needles are specialized medical devices designed for accessing the subarachnoid space to obtain cerebrospinal fluid (CSF) or deliver medications. Their proper selection and use are crucial in pediatric practice.
Key Points:
- Available in various sizes (20-25G)
- Specialized design to minimize tissue trauma
- Age-appropriate selection crucial
- Requires precise technique
- Essential diagnostic and therapeutic tool
Needle Types and Specifications
- Quincke Needles
- Traditional cutting needle
- Beveled tip design
- Higher flow rates
- More affordable
- Higher post-LP headache risk
- Sprotte/Whitacre Needles
- Pencil-point design
- Atraumatic tip
- Side port for CSF collection
- Lower post-LP headache risk
- More expensive
Size Selection Guide
- Neonates and Young Infants
- 22-25G recommended
- 30-40mm length
- Shorter bevel preferred
- Older Infants and Toddlers
- 22G standard
- 40-50mm length
- Children and Adolescents
- 20-22G common
- 70-90mm length
- Consider body habitus
Clinical Indications
- Diagnostic Purposes
- Suspected meningitis/encephalitis
- Subarachnoid hemorrhage
- Guillain-Barré syndrome
- Multiple sclerosis
- Pseudotumor cerebri
- Leukemia/lymphoma evaluation
- Therapeutic Purposes
- Intrathecal chemotherapy
- Antibiotics administration
- CSF pressure reduction
- Spinal anesthesia
- Contraindications
- Absolute
- Increased intracranial pressure with mass effect
- Local infection at puncture site
- Uncorrected coagulopathy
- Relative
- Thrombocytopenia
- Cardiorespiratory compromise
- Vertebral deformities
- Absolute
Lumbar Puncture Technique
- Preparation
- Verify indications/contraindications
- Obtain informed consent
- Select appropriate needle
- Gather equipment
- Consider topical anesthesia
- Positioning
- Lateral decubitus position (preferred)
- Spine parallel to bed
- Knees to chest
- Neck neutral
- Sitting position (alternative)
- Back to practitioner
- Shoulders relaxed
- Feet supported
- Lateral decubitus position (preferred)
- Landmark Identification
- Locate L3-L4 or L4-L5 interspace
- Mark entry point
- Clean with antiseptic solution
- Allow to dry completely
- Needle Insertion
- Use sterile technique
- Insert at midline
- Advance slowly with stylet in place
- Aim slightly cephalad
- Monitor for "pop" sensation
CSF Collection Protocol
- Initial Steps
- Remove stylet slowly
- Observe for CSF flow
- Measure opening pressure if indicated
- Collection Sequence
- Tube 1: Cell count/differential
- Tube 2: Culture/gram stain
- Tube 3: Glucose/protein
- Tube 4: Additional studies
- Volume Guidelines
- Neonates: 0.5-1.0 mL per tube
- Infants: 1-2 mL per tube
- Children: 2-3 mL per tube
Potential Complications
- Immediate Complications
- Pain at puncture site
- Bleeding
- Failed procedure
- Nerve root irritation
- Early Complications
- Post-LP headache
- Back pain
- Radicular symptoms
- Local infection
- Late Complications
- Epidermoid tumors
- CSF leak
- Chronic back pain
- Adhesive arachnoiditis
Special Considerations
- Age-Specific Considerations
- Neonates
- Use smallest appropriate gauge
- Consider fontanelle pressure
- Monitor temperature regulation
- Infants
- Higher success rate with sitting position
- Consider sedation
- Monitor vital signs closely
- Older Children
- Address anxiety
- Explain procedure
- Consider local anesthesia
- Neonates
- Post-Procedure Care
- Bed rest (controversial)
- Hydration encouragement
- Pain management if needed
- Monitor for complications
- Document procedure details
