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Reducing sedated lumbar punctures in pediatric patients with acute lymphoblastic leukemia
  • Torin Waters,
  • David Dickens
Torin Waters
University of Iowa
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David Dickens
University of Iowa
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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.

Peer review status:ACCEPTED

25 Jun 2021Submission Checks Completed
25 Jun 2021Assigned to Editor
25 Jun 2021Submitted to Pediatric Blood & Cancer
29 Jun 2021Reviewer(s) Assigned
13 Jul 2021Review(s) Completed, Editorial Evaluation Pending
14 Jul 2021Editorial Decision: Revise Minor
19 Jul 20211st Revision Received
19 Jul 2021Submission Checks Completed
19 Jul 2021Assigned to Editor
20 Jul 2021Review(s) Completed, Editorial Evaluation Pending
20 Jul 2021Editorial Decision: Accept