Clinical Nurse Children's Hospital of Colorado Denver, Colorado, United States
Title: Unsedated (Without General Anesthesia) Lumbar Puncture Algorithm
Abstract : The standard of care at Children’s Hospital of Colorado (CHCO), is to sedate patients with general anesthesia receiving lumbar punctures (LP) for diagnosis, treatment, and surveillance in the Center for Cancer and Blood Disorders (CCBD). Procedures such as bone marrow aspirates or LPs for children who have a history of traumatic taps or are under the age of 12, should receive general anesthesia to reduce trauma. However, evidence shows that cumulative doses of anesthesia exposure are associated with neurocognitive impairment in children with chronic diseases, including malignancies, that there is parental/patient preference for unsedated procedures due to decreased anxiety and reduced length of stay, and supports a standardized screening process for patients to receive unsedated procedures. CHCO has 2 patients who have received unsedated procedures previously, but no standardized algorithm for which patients are screened eligible.
In pediatric oncology patients, does implementing a standardized algorithm for unsedated LPs in the CCBD Procedure Clinic increase the number of unsedated lumbar punctures performed?
CCBD nurses collaborated with a multidisciplinary group to develop an algorithm outlining eligibility criteria for oncology patients to be offered unsedated procedures. Once patients are screened eligible, they can choose to receive their next LP unsedated or decline. If the patient chooses to proceed with an unsedated LP, the patient/family receives additional education and resources on the process and what to expect. On the day of the unsedated LP, patients have access to standard care support (i.e. child life, lidocaine/prilocaine cream, etc.) and minimal sedation if needed. Additional outcomes are being collected post intervention to evaluate the utilization of the algorithm and to maintain patient quality and safety.
Since October 2024, 7 patients have received unsedated procedures, 18 eligible patients have declined, 1 patient opted out after their first procedure, and only 1 patient reported pain.
