Holding babies for lumbar punctures

[charlimoon]

Hi, I have been working on a paediatric ward in the UK for about 18 months now. Yesterday I was looking after two babies both with suspected sepsis, both who required lumbar punctures. They had already been treated with IV antibiotics for 24 hours and were both clinically quite well, considering. I have seen and assisted with LPs several times before but never held on my own. The doctor managed to get clear samples on both babies on the first try, so I'm pretty sure I held them both fine, but I was holding them so firmly I'm worried I will have left some kind of bruising. Does this happen with this kind of procedure? Did I hold them too tight? I'm quite a small, weak little thing and the muscles of my upper arms and shoulders are really hurting this morning! I've held many children and babies for bloods and cannulas and never left a bruise before... I'm not in for a few days now and I guess I'm just worried about what may happen/be said while I'm not there (I don't even know that there is any bruising at all but I'm massively overthinking this!!).

[OldDude]

If it's prolonged involving multiple attempts, maybe, but unlikely otherwise. LPs on infants are always hardest on the one holding. You got a good sample, try not to worry about it. Sounds like you did a great job.

[NotReady4PrimeTime, RN]

What OldDude, RN said. It's an uncomfortable and unnatural position for both the child and the person holding them. I've had sore shoulders after more than one LP over the years. My technique has evolved a bit and I now raise the bed to a height comfortable for the person doing the LP, then rest my elbows on the mattress. I wrap my hands and forearms around the child's head and bum with my fingers outstretched so that I have stability in my arms to take some of the load. There's no reason why the person doing the LP can't put the drapes over top of your arms since they're going to cleanse only a small area through a fenestrated drape any way.

[KelRN215, BSN, RN]

When I worked inpatient peds neuro, we did LPs in the treatment room with conscious sedation but they were rarely successful on the floor. Most of our kids ended up going to the OR for the procedures under general anesthesia. And I know all my ALL patients when I was a visiting nurse (including the teenagers) got their q 18 week LPs with IT chemo under full sedation, not conscious. What kind of sedation was this baby under?

[OldDude]

When I worked inpatient peds neuro, we did LPs in the treatment room with conscious sedation but they were rarely successful on the floor. Most of our kids ended up going to the OR for the procedures under general anesthesia. And I know all my ALL patients when I was a visiting nurse (including the teenagers) got their q 18 week LPs with IT chemo under full sedation, not conscious. What kind of sedation was this baby under?

Typically on the infants, in the ER, there was no sedation and no local anesthesia.