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[A positioning pillow to improve lumbar puncture in paediatric haematology-oncology patients: a randomized controlled
P Marec-Bérard1, A Bissery, K Kebaïli
1Centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex 08, France, Service de biostatistique des hospices civils de Lyon, laboratoire biostatistique-santé université Claude-Bernard, CNRS UMR 5558, 162, avenue Lacassagne, 69003 Lyon, France, Service d'hématologie pédiatrique, hospices civils de Lyon, 69005 Lyon, France, Inserm, CIC201, Epicim, service de pharmacologie clinique du CHU de Lyon, UMR 5558, université de Lyon, 69000 Lyon, France.
Insights
A positioning pillow may improve lumbar puncture success rates in children, particularly those over six years old. This intervention shows promise for enhancing pediatric procedures and patient comfort during cancer treatment.
Area of Science:
- Pediatric Oncology
- Medical Device Innovation
- Procedural Comfort
Background:
- Lumbar punctures (LPs) are frequent in pediatric cancer patients.
- Standardized pain management exists, but stress and anxiety during LPs require further attention.
- Optimizing LP success and patient experience is crucial for effective treatment.
Purpose of the Study:
- To assess if a positioning pillow enhances LP success rates in awake pediatric patients.
- To evaluate the pillow's impact on child pain, cooperation, and satisfaction.
- To determine if the pillow aids in achieving maximum lumbar flexion and muscle relaxation.
Main Methods:
- A randomized controlled trial involving 124 children (aged 2-18) undergoing LPs.
- Children were assigned to either a positioning pillow group or a control group (no intervention).
- Primary outcome: first-attempt LP success rate; Secondary outcomes: pain, satisfaction, cooperation, and post-LP syndrome.
Main Results:
- The LP pillow group showed a trend towards increased success rates (67% vs. 57%, P=0.23) and reduced post-LP syndromes (15% vs. 24%, P=0.17).
- In children over six years old, the pillow significantly improved LP success rates (58.5% vs. 41.5%, P=0.031).
- A tendency for reduced pain and increased satisfaction was observed in the older children's group using the pillow.
Conclusions:
- A positioning pillow offers benefits for lumbar punctures in children, particularly those aged six and above.
- The device shows promise in improving procedural success and patient experience.
- Further research may confirm the statistical significance of these positive trends.
Abstract:
ObjectivesLumbar punctures (LPs) are common in children with cancer. Although pain management during the LP has been well standardised, dealing with stress and anxiety is not well addressed yet. Our objective was to evaluate the potential improvement of the LPs success rate using a positioning pillow, to ensure maximum lumbar flexion, and allow paravertebral muscles to relax, in children who are awake, with either conscious sedation or no sedation.Patients and methodsChildren aged 2-18 years undergoing LPs were randomly assigned to a positioning pillow or no intervention. The primary outcome was the rate of success, i.e. achieving the LPs (sampling or injection) at the first attempt, without bleeding (RBC < 50/mm3). The secondary outcomes included: the child's pain, assessed by a self-administered visual analogical scales (VAS) for children over 6 years of age; the parents' and caregivers' perception of the child's pain; the satisfaction of the children, the parents, the caregivers and the physician. The child's cooperation and the occurrence of post-LP syndrome were also evaluated.ResultsOne hundred twenty-four children (62 in each group) were included. The LP pillow tended to increase the success rate of LPs (67 vs 57%; P = 0.23), and decreased the post-LP syndromes (15 vs 24%; P = 0.17) but the differences were not statistically significant. In children over 6-year of age (N = 72), the rate of success was significantly higher in the pillow group (58.5 vs 41.5%; P = 0.031), with a tendency to feel less pain (for less pain and better satisfaction) [median VAS: 25 vs 15 mm; P = 0.39] and being more satisfied (84.4 vs 75.0%; P = 0.34).ConclusionEven if the results presented here are not as optimistic as we might have wished, we can confirm that there is a benefit in using this pillow for LPs. It is especially promising in children over 6-year of age.