Quick technical question

[chrisv]

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So if you were to do your first spinal, what size needle would you most likely want to use? In terms of, what might be the easiest for a student?

 

[drccw]

So if you were to do your first spinal, what size needle would you most likely want to use? In terms of, what might be the easiest for a student?

Sorry, performing a spinal isn't about doing what's easiest for the student....

If you're interested in doing what's easiest, then try to scam a lumbar puncture from one of the hapless medicine resident... they typically use 20G needles if I'm not mistaken....

25G spinal needles are typically the standard... Larger needles should only be used if the operator experiences much difficulty with a 25G....

The risk of PDPH increases with increasing size of needle...

drccw

 

[chrisv]

so you're telling me that a 22G needle might be easier for a novice medical student?

Sorry, performing a spinal isn't about doing what's easiest for the student....

If you're interested in doing what's easiest, then try to scam a lumbar puncture from one of the hapless medicine resident... they typically use 20G needles if I'm not mistaken....

25G spinal needles are typically the standard... Larger needles should only be used if the operator experiences much difficulty with a 25G....

The risk of PDPH increases with increasing size of needle...

drccw

 

[nap$ter]

So if you were to do your first spinal, what size needle would you most likely want to use? In terms of, what might be the easiest for a student?

if you are a medical student doing your first spinal you should use the needle your attending or resident hands you.

 

[pgg]

so you're telling me that a 22G needle might be easier for a novice medical student?

He's telling you that your needle size should be selected based on patient characteristics and reassessed if difficulty is encountered. Post dural puncture headaches are miserable, and starting with a 22 or 20 g cutting needle for a routine spinal is barbaric. 🙂

You're not going to be doing your first spinal unsupervised (I hope). With good patient selection (ie, not the 400 pounder for your first try), good patient positioning, and a little guidance, it is absolutely reasonable to expect that anyone can nail their first spinal with the standard 25g needle in the kit. You'll get it.


ETA - what slavin said

 

[TrustMe]

The bigger the needle, the easier it is to direct, generally speaking. Also, as said before, the bigger the needle, the greater the risk for PDPH. If it is spinal for a total joint replacement on a 75 y/o you can probably get away with using whatever size you want. I have tapped an older pt. with a 20ga. introducer for a spinal and they didn't get a headache. If it is a spinal for a C/S or any young pt., you should use a 24 or 25ga pencil point (Pencan, whitaker) as this will give you lowest risk of PDPH. I have done blood patches on young pt's who had an LP by another physician (neurologist) with a 22ga needle. If they are young, use the smallest you can, if they are old, pick which is easiest for you. I had attending that encouraged us to use 27ga spinal needles for C/S. That will give you almost no chance of a PDPH, but those are crazy hard to direct.

Good luck.

 

[Mman]

so you're telling me that a 22G needle might be easier for a novice medical student?

No. For a novice medical student, the size of the needle is not the rate limiting step. You would be starting with a 25 g needle. And if you were struggling, I'd help you direct the 25 g needle. And if we were still struggling I'd try to do it myself with the 25 g needle. And if that didn't work, we'd try a different interspace with a 25 g needle.

If none of that worked, I'd do it myself with a 22 g needle.

You would never start with a 22 g needle. I've done thousands and I would never start with a 22 g needle.

 

[imfrankie]

No. For a novice medical student, the size of the needle is not the rate limiting step. You would be starting with a 25 g needle. And if you were struggling, I'd help you direct the 25 g needle. And if we were still struggling I'd try to do it myself with the 25 g needle. And if that didn't work, we'd try a different interspace with a 25 g needle.

If none of that worked, I'd do it myself with a 22 g needle.

You would never start with a 22 g needle. I've done thousands and I would never start with a 22 g needle.

Patient is an old guy for something, put the 22 in and do it in two seconds without an introducer. The CSF comes out fast, you know it's in, you're done, no fussing around. Lateral, prone, upside down, whatever. Get it done. Young person--different story.

 

[epidural man]

So if you were to do your first spinal, what size needle would you most likely want to use? In terms of, what might be the easiest for a student?

17gauge Tuohy - best damn spinal needle made.

 

[Gimlet]

17gauge Tuohy - best damn spinal needle made.

 

[drccw]

17gauge Tuohy - best damn spinal needle made.

I would argue that it's the best damn introducer made....

if you're doing your spinals with a 17G tuohy.......

drccw

 

[proman]

17gauge Tuohy - best damn spinal needle made.

I see your 17 ga and raise you a 14 ga.

 

[BLADEMDA]

Patient is an old guy for something, put the 22 in and do it in two seconds without an introducer. The CSF comes out fast, you know it's in, you're done, no fussing around. Lateral, prone, upside down, whatever. Get it done. Young person--different story.

You are correct. If the patient is elderly the size of the needle matters less than whether it is a cutting or non cutting needle. A 22 Whitacre is superior to a 25G Q. In fact, in the elderly patient population the chance of a H/A with any needle is low, extremely low.

http://www.biomedsearch.com/nih/Postspinal-headache-in-young-elderly/2672869.html
http://www.ncbi.nlm.nih.gov/pubmed/20148254
http://www.ncbi.nlm.nih.gov/pubmed/1467102