lumbar punctures on infants?

Specialties Emergency

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I am a new ER nurse. I have always managed to avoid holding an infant for a spinal tap...Yesterday I ended up with a 23 day old who presented with a 100.8 fever. Doc orders the full workup:uhoh21: I manage to stick a feeding tube in his uncirc'd member, swab his nose (twice) start an IV with lab draws and blood culture and try to comfort his (non english speaking) family. This was nothing compared to what the doc did. I knew the position to hold baby in. (I had at least SEEN that) but no matter what this doc did, he could not get spinal fluid. He poked this baby 5 times.:crying2:

I have two questions...Did I do something wrong in my holding technique? I asked the doc a couple of times if he wanted me to change my positioning and he kept saying "no we are fine" But, I'm actually feeling guilty! As if it were my fault that this little guy got poked so many times. Second question...Why could this doc not get fluid? He kept saying "I know I'm in the right spot" It was the end of my shift and I didn't ask the doc any questions. For one, I didn't want to look stupid and for two, I was really upset about the full workup on this baby.

thoughts?

on babies (esp. boys), sometimes the straight caths are too stiff/too big to pass through the sphincter. we commonly use 5/8 fr. feeding tubes on males

ok...that is good to know. very limited infant care here. thanks !

i personally think the straight cath kids for adult females are too stiff.

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on babies (esp. boys), sometimes the straight caths are too stiff/too big to pass through the sphincter. we commonly use 5/8 fr. feeding tubes on males

yea...that:chuckle he was not circ'd and for some reason that seems to make it harder to pass the cath. (ok, at least for moi.) and he was absolutely tiny...

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are the rules changing for babes under 2 months with fever? in the peds er i used to work, anyone under 2 months with fever over 100 got the "works". (I always found the residents had better luck with the sitting position.) The tap, I think, is much harder on us than the kids...anyhow, would be interested to know if weptic work ups are still the gold standard for babies with fever...

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In nearly 20 years of ER nursing I have helped with countless LPs on both kids and adults. Sometimes it's the skill of the doctor. Sometimes it just ain't gonna happen. I have never seen a tap fail because of how the pt was being held. It's actually EASIER to hold newborns for a tap than any other age because they're a) so flexible and b) so tiny that they can't fight that hard.

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are the rules changing for babes under 2 months with fever? in the peds er i used to work, anyone under 2 months with fever over 100 got the "works". (I always found the residents had better luck with the sitting position.) The tap, I think, is much harder on us than the kids...anyhow, would be interested to know if weptic work ups are still the gold standard for babies with fever...

we do the works. u/a, blood, iv,lp,nasal swabs...The ones that make me nuts are the paren'ts that say "he's had a fever at home of over 100" but the kiddo is perfect 98 at triage. Sometimes our younger docs get all worked up and order the full workup:chair:

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Specializes in Pediatric ER.
are the rules changing for babes under 2 months with fever? in the peds er i used to work, anyone under 2 months with fever over 100 got the "works". (i always found the residents had better luck with the sitting position.) the tap, i think, is much harder on us than the kids...anyhow, would be interested to know if weptic work ups are still the gold standard for babies with fever...

it's pretty much the same. the american academy of pediatric recommends a workup on babies less than 90 days with a fever >100.4. when we do a workup, we do ua/uc, cbcd, bmp, bld cx, csf, rsv/flu (depending on the season), cxr, and start ivf and abx.

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I think that ER docs shouldn't do lumbar punctures on little babies, I think if it were my kid...under fluroscopy or forget it, for that matter if it were me under fluro or forget it!

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what s/s was this baby exhibiting? A temp of 100 does not justify the risks.Anytime you do a tap...you have possibly introduced bacterial contaminants simply by accessing that csf. Not to mention the risks of tentorial herniation from the actual tap itself....that can progress to brain death. I just hate the fact that people treat taps as an ok routine procedure just like a lab draw. It carries risks....tentorial herniation and brain death.We do taps too on babies....and either it was your docs inexperience, lordosis, or the kid was dehydrated.Other than the low grade temp...what symptom did the child exhibit to qualify them for a tap?

I have had young kids...who their taps turned out negative from meningitis&tb...but that just bc of the shift/change in pressure...they have herniated and died. These were kids that had negative CT's And MRI's pretap...so there are huge risks to any tap.:nono: :nono: :madface: :nono: :nono:

but...it sounds like you were not to blame at all for the 5 sticks.....it was probably just dehydration .Think about it....what other s/s manifests itself with dehydrated babes? sunken fontanelles???????why are those fontanelles sunken?????/

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