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. 2014 Jul;31(4):230-238.
doi: 10.1177/1043454214532026.

Evidence-Based Practice Recommendations to Prevent/Manage Post-Lumbar Puncture Headaches in Pediatric Patients Receiving Intrathecal Chemotherapy

Rebecca Rusch  1 , Christina Schulta  1 , Laura Hughes  2 , Janice S Withycombe  3
Affiliations

Evidence-Based Practice Recommendations to Prevent/Manage Post-Lumbar Puncture Headaches in Pediatric Patients Receiving Intrathecal Chemotherapy

Rebecca Rusch et al. J Pediatr Oncol Nurs. 2014 Jul.

Abstract

Post-lumbar puncture headaches (PLPHs) are a known complication of lumbar puncture procedures. Children undergoing treatment for cancer often undergo multiple lumbar punctures, placing them at increased risk for PLPHs. There are currently no guidelines for the prevention or management of PLPHs in children. A team was therefore assembled to conduct a systematic review of the evidence in relationship to PLPHs in the pediatric population. Clinical questions were developed and used to guide the literature review. Twenty-four articles were deemed appropriate for use and were evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Based on the review of evidence, strong recommendations are made for the use of smaller needle sizes and for the use of pencil point needles during lumbar puncture procedures. Weak recommendations are made for needle orientation and positioning following the procedure as well as for interventions used to treat PLPHs once they occur. There is a need for additional, pediatric-specific studies to further examine the issue of PLPH prevention and treatment.

Keywords: headache; lumbar puncture; pediatric; prevention; treatment.

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Conflict of interest statement

Authors’ disclosure of potential conflicts of interests:

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

FIGURE 1
FIGURE 1
Evidence search strategy
FIGURE 2
FIGURE 2
Needle Types Top= Cutting Point Needle; Bottom = Pencil Point Needle Illustrations by: Aimee D. Ermel, Eugene and Ruth Roberts Academy Student, City of Hope
See this image and copyright information in PMC

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