Little Tubes, Little LabsFull episode audio for MD edition217:13 min - 303 MB - M4AEM:RAP 2017 April French EditionFrançais38:53 min - 53 MB - MP3EM:RAP 2017 April Spanish EditionEspañol103:05 min - 141 MB - MP3EM:RAP 2017 April Canadian EditionCanadian15:44 min - 22 MB - MP3EM:RAP 2017 April Australian EditionAustralian25:20 min - 35 MB - MP3EM:RAP 2017 April German EditionDeutsche73:56 min - 102 MB - MP3EM:RAP 2017 April Board Review Answers216 KB - PDFEM:RAP 2017 April Board Review Questions169 KB - PDFEM:RAP 2017 April Individual Files - MP3288 MB - ZIPEM:RAP April Written Summary577 KB - PDF
Alastair M. - April 11, 2017 2:34 AM
This winds me up too! In our hospital I have developed an LP pack that has a 25G and 22G whittacre needle in it and removed all the quinke (cutting) needles to force change about 3 years ago. I then went to the medical hand over with a pre- anaesthetised portion of my thigh and showed the 22G would go through the skin. In real cases though I normally use the introducer from the 25 to creat a guide hole. I'm glad I am not the only one.
Samuel B., MD - April 17, 2017 2:05 PM
Size matters too. Using a 24 or 25 G needle markedly reduces the incidence of PDPH compared to a 22G - there are tons of references supporting this; but using a 24/25 G needle requires a 20G introducer needle to give it some support as it travels through the tissues. It's not hard to use at all - really - anesthetists do it all the time. In the 25 yo female "headache nyd" patient (probably isn't anything but I need CSF to prove it), who is at very high risk of PDPH, using the smaller needle makes good sense; save the 22G for the 75 yo "query meningitis" patient who is at lower risk for PDPH and will be a more difficult stick with the 24/25G. Sure it takes a minute or two longer to get the CSF, but it still doesn't take long to get 0.5 ml in 4 tubes which is all you need. The extra time you spend up front doing the procedure "expertly" saves so much time (yours and the patients') and discomfort at the other end if an epidural blood patch (or 3 days of bedrest) can be avoided.
Just do it - RIGHT!