LP

• LPs were more likely to be successful in infants >12 weeks of age – OR=3.1 (95% CI 1.2-8.5)
• Local anesthetic use showed increased odds of success OR=2.2 (95% CI 1.04-4.6)
• In infants ≤12 weeks of age, early stylet removal improved success rates – OR=2.4 (95% CI 1.1-5.2)
• Position (upright vs side-lying), drape use, and year of training were not significant predictors of success

The presence of a family member(s) was not associated with an increased risk of traumatic or unobtainable lumbar puncture, nor was it associated with more attempts at the procedure as seen in a study also by Nigrovic et al (3).

The viewing of an educational video prior to performing an Lumbar Puncture by a study Srivastava et al. in 2012 showed that viewing the video helps with provider comfort in performing the procedure, but it does not help in actually being successful (4).

What improves success

• Experienced holder –Can’t be stressed enough! If you can’t keep patients safely in proper position, consider procedural sedation
• Age > 12 weeks – spinal canal larger, dural pop more pronounced
• Anesthesia use (topical and injectable) – the better pain is controlled = less wiggle
• Oral Sucrose – safe, easy to administer but insufficient alone
• Early stylet removal – able to appreciate CSF flash when in spinal canal