1. Post Dural puncture headaches following intentional lumbar puncture
An audit of practice
1 Sep 2014 – 28 Feb 2015
Dr Charles Goh, Dr Eoin Kelleher,
Dr Tom Owens

2. Introduction
Post Dural Puncture Headache is a recognised complication of Dural Puncture.
Treatment can be conservative (analgesia, bed rest, caffeine) or invasive (epidural blood patch, neurosurgical repair)
There was a perceived high incidence of requests for epidural blood patches in early 2015.
Audit undertaken to determine incidence of PDPH in St Vincent’s University Healthcare Group

3. Method Period audited: 1 September 2014 – 28 February 2015
Records accumulated
Metavision search:
Epidural blood patches
Spinal Anaesthetics
Spinal Analgesics
Lab records: all CSF samples
Chart review:
Record of dural puncture
Follow up post dural puncture for post dural puncture headache & subsequent management.

4. Results

5. Results 382 charts to review To date: 354 charts reviewed
28 charts outstanding

7. Post Dural Puncture Headaches
Diagnostic
Anaesthesia
Analgesia
Other
Total
10 out of 114 (8.8%)
1 out of 158 (0.6%)
0 out of 71 (0%)
1 out of 11 (9%)
12 out of 354 (3.4%)

8. Outcomes of PDPH Diagnostic Anaesthetic Other Total Patched 2 1 3
Diagnostic
Anaesthetic
Other
Total
Patched 2 1 3
Not Patched 8 9 10 12

9. Removal of intrathecal pump
Epidural Blood patch
Diagnostic tap
Removal of intrathecal pump
Total 2 1 3

10. Headache relationship to needle type
Needle size/type not recorded
22G unknown type
25G Whitacre
Removal of Intrathecal pump
Total 6 4 1 12

11. Needle vs PDPH Needle size/type PDPH No PDPH Total (% PDPH)
20G unknown type 1
1 (0%)
21G unknown type
22G unknown type 4 21
25 (16%)
22G Chiba
22G Quincke
22G Whitacre 7
7 (0%)
25G Whitacre
208
209 (0.5%)
No record 6 91
97 (6%)
Not applicable 10
11 (9%)

12. Records Recorded Not recorded Not applicable Total Diagnostic 78 (68%)
Recorded
Not recorded
Not applicable
Total
Diagnostic
78 (68%)
36 (32%)
114
Anaesthetic
149 (94%)
9 (6%)
158
Analgesic
68 (96%)
3 (4%) 71
Other 11
295 (83%)
48 (14%)
11 (3%)
354

13. Needle recorded Recorded Not recorded Not applicable Total Diagnostic
Recorded
Not recorded
Not applicable
Total
Diagnostic
31 (27%)
83 (73%)
114
Anaesthetic
147 (93%)
11 (7%)
158
Analgesic
68 (96%)
3 (4%) 71
Other 11
246 (70%)
97 (27%)
11 (3%)
354

14. Others (11 cases) No spinal performed: 5
Epidurals (no dural puncture): 4
Otorrhoea (fluid sample to confirm as CSF): 1
Removal of intrathecal pump: 1

15. Diagnostic LP breakdown by specialty
PDPH?
Needle used
Anaesthetics/ICU 9
No Headache
22G unknown 1
25G Whitacre 3
Not Recorded 5
Emergency Medicine 13
Headache 2 11
Medical 55 52
20G unknown 49
Neurology 19 17 8
Radiology 18 15
21G unknown 10
22G Chiba
Not recorded

16. Diagnostic LP record keeping by specialty
Needle record
No.
Procedure record
Anaesthesia / ICU
Recorded 4 6
Not Recorded 5 3
Emergency Medicine 8 13
Medical 37 52 18
Neurology 9 12 10 7
Radiology 15

17. Other findings
Metavision printout – no details of spinal (record in the medical notes does not report the person who performed the spinal – even though this is recorded on the system)
Metavision record – notes section needs to be filled in to document ease/difficulty of spinal
No universal record format for diagnostic lumbar punctures

18. Pencil point vs cutting needles! & calibre!