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QUESTION 2: Is the lateral decubitus position best for successful paediatric lumbar puncture?
  1. Caroline Hart1,
  2. Andrew Thompson1,
  3. Paul Moriarty2
  1. 1General Paediatric Department, Royal Belfast Hospital for Sick Children, Belfast, UK
  2. 2Paediatric Infectious Diseases Department, Royal Belfast Hospital for Sick Children, Belfast, UK
  1. Correspondence to Dr Caroline Hart, General Paediatric Department, Royal Belfast Hospital for Sick Children, 180-184 Falls Road, Belfast BT12 6BE, UK; caroline.hart{at}belfasttrust.hscni.net

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Clinical scenario

You are a paediatric registrar who is called by the emergency department to assess a febrile 13-month-old infant. On clinical review of the infant, you feel a lumbar puncture (LP) is indicated and they are stable enough for the procedure. On preparing the infant one of the new staff nurses in the department asks you in what position you would prefer the baby to be held. She has seen children in another unit being placed in both lying and sitting positions for LP.

You are only familiar with the lateral decubitus position and proceed with this technique. Later you wonder if positioning influences the likelihood of success in paediatric LP.

Structured question

In infants and children requiring diagnostic LP (patient) is the lateral decubitus position (intervention) most likely to produce the greatest rate of success (outcome)?

Search strategy and outcome

We searched Medline, EMBASE and PubMed using the key words lumbar puncture, cerebrospinal fluid and position. The search was undertaken in February 2016. The results were then filtered to only include children. 149, 187 and 327 abstracts were obtained from Medline, EMBASE and PubMed, respectively. However, there was significant overlap. Abstracts included were those describing studies which compared the lateral decubitus against any other LP position using outcomes such as success, atraumatic tap or proxy measures for this. We excluded articles which only addressed the safety of various positions, though we have considered safety in our discussion (figure 1–3).

Figure 1

Lateral decubitus position.

Figure 2

Lateral decubitus position with 45° head up tilt.

Figure 3

Sitting position.

On review of the abstracts, we found 13 that were eligible for full …

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