Effect of spinal needle characteristics on measurement of spinal canal opening pressure

• Published in: The American journal of emergency medicine Vol. 35; no. 5; pp. 769 - 772
• Main Authors: Bellamkonda, Venkatesh R., Wright, Thomas C., Lohse, Christine M., Keaveny, Virginia R., Funk, Eric C., Olson, Michael D., Laack, Torrey A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2017; Elsevier Limited
• Subjects: Cerebrospinal fluid; Cerebrospinal Fluid Pressure; Emergency medical care; Headache; Headaches; Humans; Intracranial hypertension; Manikins; Needles; Neurology; Pressure; Pressure measurement; Process improvement; Simulation; Spinal puncture; Spinal Puncture - instrumentation; Throughput; Time measurement; Variance analysis; RVU; Headache; LP; Intracranial hypertension; Process improvement; CSF; Needles; Throughput; Spinal puncture; TTM; OPM
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2017.01.047

A wide variety of spinal needles are used in clinical practice. Little is currently known regarding the impact of needle length, gauge, and tip type on the needle's ability to measure spinal canal opening pressure. This study aimed to investigate the relationship between these factors and the opening-pressure measurement or time to obtain an opening pressure.
Thirteen distinct spinal needles, chosen to isolate the effects of length, gauge, and needle-point type, were prospectively tested on a lumbar puncture simulator. The key outcomes were the opening-pressure measurement and the time required to obtain that measure. Pressures were recorded at 10-s intervals until 3 consecutive, identical readings were observed.
Time to measure opening pressure increased with increasing spinal needle length, increasing gauge, and the Quincke-type (cutting) point (P<0.001 for all). The time to measurement ranged from 30s to 530s, yet all needle types were able to obtain a consistent opening pressure measure.
Although opening pressure estimates are unlikely to vary markedly by needle type, the time required to obtain the measurement increased with increasing needle length and gauge and with Quincke-type needles.