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Discussion

LP with chemo in peds

In our out patient surgery center we occasionally do LP's with chemo for a pediatric oncologist (his oncology nurse comes also.)

Unfortunately (or fortunately ? ) for various reasons I hadn't worked recovery in a long time, been dong pre-op, and hadn't taken care of these cases in recovery.

I kind of got dumped on and took the patient. I don't mind peds, I don't mind these cases. However several years ago our center made a big push for using specially trained or oriented nurses specifically for pediatric cases.

Well.....apparently that idea was not written in stone, or written at all, because here I get the kiddo. As i said I hadn't even been working recovery much, and hadn't been in on the special peds nurse "training." I only work part time. He was absolutely fine medically (of course has ALL, but you know what I mean, he was really stable.)

Well the whole point of my question....and I do have one....is I let the kiddo sit up right away. he was kind of groggy moving around mumbling....I asked if he wanted juice or an otter pop, he said yea, sat up and ate an otter pop.

Then I found out it is preferred that these LP with chemo kids ideally lie flat for 1/2 to 1 hour so the chemo ??? circulates ??? or something better.

Is that valid...evidence based? Laying flat after LP's with chemo?

After he sat up, ate his otter pop, he quietly laid back down and slept so honestly I think mine letting him sit up, eat a pop, worked out find. And the oncologist happened to walk by and his only comment was...boy he wakes up quickly.

Sorry, I am rambling on a lot. But basically...should LP chemo kids lie flat?

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    • Featured Replies

    Lying flat is the general recommendation after any lumbar puncture... with or without intrathecal meds.

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    • Expert

    Agree with Kel; having the child lie flat at least 1/2 hour helps prevent spinal H/A. Also, it would be a good idea to have these pts.cared for by someone who has a current chemo provider card.

    Sorry you were tossed in the deep end.

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    I had always thought that too, about LPs, and just yesterday I had a patient go straight from an LP to a bone marrow biopsy. I questioned it because they are supposed to lie flat, and the guy down where they do the LP told me they don't recommend that anymore. What the heck happened?

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    In my previous job as a hem/onc NP, I did LPs and IT chemo for ALL patients in an outpatient setting.

    They were adults.

    As soon as I was done and had put a bandaid over the LP site, my patients were hopping off the bed and running down the halls to get away.

    I hadn't even had time to put away my LP tray etc.

    I'd have to stand in the hallway and holler after them to drinks lots of fluid/hydrate and have some caffeinated drinks.

    They were all fine.

    It took longer to set up the LP tray and collection tubes than it took to do the actual LP and IT chemotx/

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    We used to do LP chemo as well. Lying down for 30-60 minutes post-procedure was required and absolutely standard--no exceptions.

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    I don't believe that it has ever been proven that lying down after an LP decreases side effects of headaches, etc.

    If it is the patient's first time...good idea.

    If they have had many...hydration and caffeinated drinks, no strenuous activities usually does the trick

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    • Author

    I hadn't visited this post probably since it was posted! As usual the answer is "clear as mud" maybe ideally yes, maybe doesn't really matter that much?

    However even if evidence based practice shows lying down is best.....I think letting him sit up 5 minutes, eat an otter pop, then he laid down and slept is a much better option or outcome than the staff and his parents spending ?? 10 - 15 minutes, struggling with a groggy unhappy peds patient, holding him down, telling him over and over..."you have to lie flat so the medicine works better!" I can even see some nurses getting anesthesiologist to write an IV versed order if it became a big struggle!

    And of course I haven't recovered a peds s/p chemo patient since then!

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