Reducing sedated lumbar punctures in pediatric patients with acute
lymphoblastic leukemia
Abstract
Background: Sedation for lumbar punctures (LPs) in pediatric acute
lymphoblastic leukemia (ALL) patients has been the standard for decades
to reduce pain and anxiety. Recent studies on the potential long-term
neurocognitive effects of cumulative propofol exposure has raised
concerns about this practice. The recent pandemic introduced additional
burdens to patients, with the requirement of a negative COVID-19 test
prior to each sedated procedure. Procedure: These factors prompted a
quality improvement intervention at our institution where we aimed to
reduce post-Induction sedated lumbar punctures (LPs) by 50%. Our
intervention included patient and family education followed by a
simulation of the procedure for selected patients. Those converted to
unsedated LPs were queried for their preference. Comparative cost,
clinical time and LP success rates were collected for sedated and
unsedated LPs. Results: Following the intervention, the percentage of
LPs performed with sedation dropped from 100% to 48.1%. All LPs were
successful using both techniques. Most patients who experienced the
unsedated LP technique, and their guardians, strongly preferred this
approach. Unsedated LPs significantly reduced clinical time (169 vs 83
minutes) for families, decreased expenditures ($5,736.16 reduction per
procedure) and improved institutional opportunity cost due to a decrease
in last-minute cancellations. Conclusion: We have shown that it is
feasible to significantly reduce the use of sedation for LPs in patients
with ALL, which has the potential to improve health and patient
experience at a lower cost.