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Optimizing Analgesic Use During Infant Lumbar Puncture in the Emergency Department

Erin E Balay1, Marissa A Hendrickson2,1, Brian Harvey1

  • 1The University of Minnesota Medical School, Minneapolis, Minn.

Pediatric Quality & Safety
|May 20, 2020
PubMed

Insights

Infant lumbar puncture (LP) pain management improved with a new system, increasing the use of multiple analgesics. This ensures better pain relief during this essential diagnostic procedure for infants.

Area of Science:

  • Pediatric Emergency Medicine
  • Pain Management
  • Clinical Quality Improvement

Background:

  • Lumbar puncture (LP) is crucial for diagnosing febrile or ill-appearing infants.
  • The procedure is painful, and inadequate analgesia can have adverse effects.
  • Current guidelines recommend analgesia, but oral sucrose alone is insufficient.

Purpose of the Study:

  • To analyze analgesic use trends during infant LPs in an emergency department.
  • To implement a system for standardized analgesic administration.
  • To achieve complete compliance with at least one analgesic and increase multi-analgesic use to 85%.

Main Methods:

  • Utilized Plan-Do-Study-Act methodology and retrospective chart review.
  • Implemented five interventions focused on staff communication, collaboration, and education.
  • Included infants under 60 days with fever, hypothermia, or ill appearance undergoing LP.

Main Results:

  • Analyzed 100 infant LPs (52 preintervention, 48 intervention).
  • Increased the use of two or more analgesics from 58% to 87%.
  • Topical lidocaine use rose from 56% to 73%; LP success rates remained high.

Conclusions:

  • A streamlined process was established to ensure all infants received at least one analgesic during LP.
  • Significantly increased the proportion of infants receiving multiple analgesics.
  • The model can be adapted for other invasive procedures in pediatric emergency care.
Abstract

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