The type of needle used during a lumbar puncture makes a significant difference in the subsequent occurrence of headache, nerve irritation, and hearing disturbance in patients, according to a study published in The Lancet.
They study also found that the pencil-point atraumatic needle with the better tip design, which has been available for about 70 years, is used by few physicians because they have not been aware of its benefits over the conventional bevelled traumatic needles.
The implications on clinical care are huge, said senior author Saleh Almenawer, MD, Hamilton Health Sciences, Hamilton, Ontario.
“There is a more than 50% reduction in the occurrence of headaches with the atraumatic needles, and also more than a 50% reduction in patient readmissions and return to emergency rooms for narcotics or blood patches.”
The study found that using atraumatic needles rather than conventional traumatic needles for lumbar punctures is just as effective and results in a significant decrease in complications such as headaches.
“The 2 needles differ in how they penetrate the thick membrane, called the dura, surrounding the nerves,” said Dr. Almenawer.
He explained that the sharp edges of the tip of a conventional needle cuts its way through, while the tip of an atraumatic needle causes the tissue to dilate and contract around it. The tiny hole left in the dura by the atraumatic needle makes it significantly more difficult for cerebrospinal fluid to leak through, thus diminishing the frequency of headaches, readmissions and treatment.
The study pooled data from 110 clinical trials, with more than 30,000 participants in 29 countries across the past 28 years.
Atraumatic needles have been around for decades, but their use remains significantly limited, according to the researchers. They also found the atraumatic needles cost the same or up to 3 times as much as the more conventional type.
“Several surveys from around the world showed that only a fraction of physicians know atraumatic needles exist, and among those even a smaller portion use the atraumatic type,” said Dr. Almenawer. “Lumbar puncture is a standard procedure, with thousands done every day around the globe by physicians of many specialties. Unfortunately, conventional needles created in 1890 are still the default in most hospitals around the world. This study provides convincing high-quality evidence for people to change to the atraumatic needles for a better patient care.”
In an accompanying editorial, Diederik van de Beek, MD, and Matthijs Brouwer, MD, University of Amsterdam, Amsterdam, the Netherlands, wrote: “Clinicians should start using atraumatic needles for lumbar punctures. We need to change practice.”