Paeds Cases · investigations-procedures-and-technology
Perform a lumbar puncture on an infant — OSCE
OSCE procedural station: assess a 4-month-old febrile infant for a diagnostic lumbar puncture, perform the pre-LP safety check, position the child, choose the needle, and outline the technique, opening pressure measurement, sample handling and complications.
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RACP DCEMRCPCH ClinicalRCPSC PediatricsABP General Pediatrics
Prompt
A 4-month-old previously well infant is brought to the emergency department with a 12-hour history of fever, irritability, and poor feeding. The temperature is 38.9°C, the heart rate 170, capillary refill 2 seconds, the anterior fontanelle is full but not bulging, and there are no focal neurological signs. The team has decided to perform a septic workup including a lumbar puncture. You are the paediatric registrar asked to assess the child and outline how you would perform the procedure safely.
Candidate brief
You have this station to assess a 4-month-old infant before a diagnostic lumbar puncture, perform the structured pre-LP safety check, position the child and choose the needle, outline the technique and the opening pressure measurement, and discuss the complications and aftercare. Treat this as a calm, planned procedure in a stable child, with an explicit safety check before any drape goes on. [1] [4]
References4ShowHide
- [1]Schulga P, Grattan R, Napier C, et al. How to use… lumbar puncture in children Arch Dis Child Educ Pract Ed, 2015.PMID 26104280
- [2]Rao S Atraumatic lumbar puncture needles are associated with fewer complications than conventional needles Arch Dis Child Educ Pract Ed, 2019.PMID 30368456
- [3]Koch BL, Moosbrugger EA, Egelhoff JC Symptomatic spinal epidural collections after lumbar puncture in children. AJNR Am J Neuroradiol, 2007.PMID 17885251
- [4]Visintin C, Mugglestone MA, Fields EJ, et al. Management of bacterial meningitis and meningococcal septicaemia in children and young people: summary of NICE guidance BMJ, 2010.PMID 20584794