Dr Charles Goh Dr Eoin Kelleher Dr Tom Owens Post Dural puncture headaches following intentional lumbar puncture Introduction Post Dural Puncture Headache is a recognised complication of Dural Puncture ID: 1046348
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1. An audit of practice 1 Sep 2014 – 28 Feb 2015Dr Charles Goh, Dr Eoin Kelleher, Dr Tom OwensPost Dural puncture headaches following intentional lumbar puncture
2. IntroductionPost Dural Puncture Headache is a recognised complication of Dural Puncture.Treatment can be conservative (analgesia, bed rest, caffeine) or invasive (epidural blood patch, neurosurgical repair)There was a perceived high incidence of requests for epidural blood patches in early 2015.Audit undertaken to determine incidence of PDPH in St Vincent’s University Healthcare Group
3. MethodPeriod audited: 1 September 2014 – 28 February 2015Records accumulatedMetavision search: Epidural blood patchesSpinal AnaestheticsSpinal AnalgesicsLab records: all CSF samplesChart review: Record of dural punctureFollow up post dural puncture for post dural puncture headache & subsequent management.
4. Results
5. Results382 charts to reviewTo date: 354 charts reviewed28 charts outstanding
6.
7. Post Dural Puncture HeadachesDiagnosticAnaesthesiaAnalgesiaOtherTotal10 out of 114 (8.8%)1 out of 158 (0.6%)0 out of 71 (0%)1 out of 11 (9%)12 out of 354 (3.4%)
8. Outcomes of PDPH DiagnosticAnaestheticOtherTotalPatched2013Not Patched8109Total101112
9. Epidural Blood patchDiagnostic tapRemoval of intrathecal pumpTotal213
10. Headache relationship to needle typeNeedle size/type not recorded22G unknown type25G WhitacreRemoval of Intrathecal pumpTotal641112
11. Needle vs PDPHNeedle size/typePDPHNo PDPHTotal (% PDPH)20G unknown type011 (0%)21G unknown type011 (0%)22G unknown type42125 (16%)22G Chiba011 (0%)22G Quincke011 (0%)22G Whitacre077 (0%)25G Whitacre1208209 (0.5%)No record69197 (6%)Not applicable11011 (9%)
12. Records RecordedNot recordedNot applicableTotalDiagnostic78 (68%)36 (32%) 114Anaesthetic149 (94%)9 (6%) 158Analgesic68 (96%)3 (4%) 71Other1111Total295 (83%)48 (14%)11 (3%)354
13. Needle recorded RecordedNot recordedNot applicableTotalDiagnostic31 (27%)83 (73%) 114Anaesthetic147 (93%)11 (7%) 158Analgesic68 (96%)3 (4%) 71Other1111Total246 (70%)97 (27%)11 (3%)354
14. Others (11 cases)No spinal performed: 5Epidurals (no dural puncture): 4Otorrhoea (fluid sample to confirm as CSF): 1Removal of intrathecal pump: 1
15. Diagnostic LP breakdown by specialtySpecialtyNo.PDPH?No.Needle usedNo.Anaesthetics/ICU9No Headache922G unknown125G Whitacre3Not Recorded5 Emergency Medicine13Headache2Not Recorded13No Headache11 Medical55Headache3Not Recorded3No Headache5220G unknown122G unknown2Not Recorded49 Neurology19Headache222G unknown1Not Recorded1No Headache1722G unknown8Not Recorded9 Radiology18Headache322G unknown3No Headache1521G unknown122G unknown1022G Chiba1Not recorded3
16. Diagnostic LP record keeping by specialtySpecialtyNeedle recordNo.Procedure recordNo.Anaesthesia / ICURecorded4Recorded6 Not Recorded5Not Recorded3 Emergency MedicineRecorded0Recorded8 Not Recorded13Not Recorded5 MedicalRecorded3Recorded37 Not Recorded52Not Recorded18 NeurologyRecorded9Recorded12 Not Recorded10Not Recorded7 RadiologyRecorded15Recorded15 Not Recorded3Not Recorded3
17. Other findingsMetavision printout – no details of spinal (record in the medical notes does not report the person who performed the spinal – even though this is recorded on the system)Metavision record – notes section needs to be filled in to document ease/difficulty of spinalNo universal record format for diagnostic lumbar punctures
18. Pencil point vs cutting needles! & calibre!