title: Change practice now! Using atraumatic needles to prevent post lumbar puncture headache.
abstract: OBJECTIVE
  Lumbar puncture (LP) is a key diagnostic procedure in medicine. Post lumbar puncture headache (PLPHA) is a well recognized complication of LP. Evidence suggests that using atraumatic needles for diagnostic LP (ATNLP) reduces risk of PLPHA. However, clinicians in Europe and the USA routinely use traumatic needles for diagnostic LP (TNLP). The occurrence of PLPHA following ATNLP and TNLP was compared in a clinical setting. Further, a survey was performed exploring use of ATNLP amongst UK neurologists.
  
  
  METHODS
  Service development study. Patients were followed up 2 and 7 days after LP using blinded telephone assessment. A questionnaire was developed to assess use of ATNLP amongst UK neurologists. Frequency, onset, duration and severity of PLPHA were recorded as were use of analgesia, general practitioner consultations, hospital readmissions, days off work due to PLPHA and cost. Neurologists were asked about their familiarity with, and use of, ATNLP.
  
  
  RESULTS
  One hundred and nine participants attending the Royal London Hospital were included, and 74 attendees of the Association of British Neurologists 2012 conference completed an on-site questionnaire. ATNLP reduced the rate of PLPHA (27.1% vs. 60.4%; P < 0.01). In those participants who developed PLPHA symptoms were short lived (mean 50 h vs. 94 h, P = 0.02) and less severe after ATNLP. Use of ATNLP led to significant cost savings. Only one in five UK neurologists regularly use ATNLP stating lack of training and availability of atraumatic needles as main reasons.
  
  
  CONCLUSIONS
  ATNLP significantly reduces the risk of PLPHA. Training is required 3 to facilitate a change from TNLP to ATNLP amongst clinicians.
authors: Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Barts Health NHS Trust, The Royal London Hospital, London, UK.
authors: A
authors: A
authors: Davis
authors: R
authors: R
authors: Dobson
authors: S
authors: S
authors: Kaninia
authors: M
authors: M
authors: Espasandin
authors: A
authors: A
authors: Berg
authors: G
authors: G
authors: Giovannoni
authors: K
authors: K
authors: Schmierer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects*; D051299:Post-Dural Puncture Headache / Q000209:etiology / Q000517:prevention & control*; D013129:Spinal Puncture / Q000009:adverse effects* / Q000295:instrumentation*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: atraumatic needle; needle design; post lumbar puncture headache