Lumbar Puncture Procedure Recommendation for Newborns.

Posted: January 7th, 2023

Lumbar Puncture Procedure Recommendation for Newborns.

I will attach word doc and made highlights to important to details to follow please Please follow the rubric to answer everything required in the paper. • VERY IMPORTANT: Critique of each research study: The critique of each of the research studies (total of 2 studies need to come from either Cochrane, Cinahl or Pubmed) should include: purpose of the study, study design, description of study sample, results of study, description of how results relevant to the recommended revision.Lumbar Puncture Procedure Recommendation for Newborns.

ORDER A PLAGIARISM-FREE PAPER HERE

Assessment of an Advanced Practice Procedure The purpose of this assignment is for the student to identify and review a procedure that NNPs (and/or neonatologists) perform in their NICU where they work as an RN and suggest improvements to the procedure based on the most current evidence for practice (i.e. research studies). Steps in the process: 1. Identify a procedure of interest Lumbar Puncture 2. Identify the existing policy for the procedure that is used by NNPs and neonatologists in the student’s NICU. My current policy does not use any type of pain medication like lidocaine when performing a Lumbar puncture on infant and only gives sucrose (sugar water with pacifier dips). 3. Explore the medical literature to identify ways that the procedure could be improved/updated (with the result of improved patient care/safety).Lumbar Puncture Procedure Recommendation for Newborns. I need literature that is no more than 5 years old the oldest it can be in 2015. The one specific recommendation I want to change in my policy is for lidocaine or analgesia for pain during the lumbar procedure 4. Make ONE SPECIFIC recommendation for policy change for the procedure with support from the current medical literature (two research studies published within the past 5 years that BOTH support the student’s recommendation). An example of a research study is a randomized controlled trial. None of the following are research studies: quality improvement reports, clinical guidelines/bundles, reports of evidence-based practice projects, meta-analyses. A major part of your grade for this assignment is your ability to identify current research, critique the research, and make an informed recommendation about the need for procedure revision. Because you are being evaluated, you may not ask your instructor to preview your research studies for appropriateness. If you are unclear on what constitutes a research study, refer back to your research text book from N5366. Assignment Rubric Points possible Points earned Procedure • Brief description of procedure (a few sentences, not a list of the steps of the procedure) • Rationale for choosing procedure • Identify the providers’ current source for the selected procedure (unit-based policy or published guideline with reference) [NOTE: Do not include the actual procedure or steps in the procedure in this paper.] 20 Recommendation for Revision • Identify the (one) revision being recommended with rationale. Lumbar Puncture Procedure Recommendation for Newborns.• Critique of each research study: The critique of each of the research studies (total of 2 studies) should include: purpose of the study, study design, description of study sample, results of study, description of how results relevant to the recommended revision. NOTE: BOTH studies must support the ONE revision being recommended. 50 Conclusion Summarize with a paragraph which includes the recommended revision with rationale and support from the two research studies critiqued in prior section. 20 Format NOTE: This section is not percentage correct, but instead, reflects points deducted for each error. Title page from N5204 course used. Paper in 12 pt Times New Roman font throughout Use the headings in this rubric for the paper: Procedure, Recommendation for Revision, Conclusion Paper in 7th edition APA format including title page, headings citations, and reference list Sources cited properly. Paper free of errors. Writing organized, clear, and free of grammatical and spelling errors. Paper 3-4 pages in length excluding title page and reference list (pages in excess of 4 will not be evaluated toward grade). 10 Total 100

To Use or Not to Use Anesthesia for Lumbar Puncture in Newborns by Neonatal Nurse Practitioners (NNPs): An Evidence-Based Recommendation for Practice Change

Lumbar puncture (LP) is a common procedure in neonates who are febrile and who may have meningitis and/ or other conditions affecting the meninges and cerebrospinal fluid (CSF). It also helps in ruling out subarachnoid hemorrhage. It is however a painful procedure making the newborn both uncomfortable and restless when it is in progress. Lumbar Puncture Procedure Recommendation for Newborns.Comfort and lack of movement are thus important during the LP procedure for its ultimate success. Local anesthesia has been shown to improve the chances of success of lumber punctures in febrile newborns. The current practice is that practitioners may use local anesthetic as an injection (which itself is painful) or a topical cream (that may not be effective at once). Because of all this, evaluated evidence suggests that not enough anesthetic is being used by practitioners during LP procedures in newborns (Fallah et al., 2016; Caltagirone et al., 2018; Goldman, 2019). This paper recommends a change to a particular current practice of not using anesthetic during LPs in newborns, based on current empirical evidence.

Procedure

LP involves inserting a needle in the vertebral column in the lumbar region (beyond the spinal cord) to withdraw a sample of CSF for microbiological and biochemical analysis. The rationale for choosing this procedure is that as a neonatal nurse practitioner (NNP) in a neonatal intensive care unit or NICU,        this is one of the most common emergency procedures that are usually done to save the life of a febrile newborn through prompt and accurate diagnosis. It is therefore imperative that it is done in line with current evidence-based practice (EBP). Presently in the NICU that I work in, the policy is in favor of not using any anesthetic while performing a LP on a newborn. Only sucrose is given to calm the baby. However, available evidence does not seem to support this practice hence the need for a change in how LPs are done in this NICU with respect to local anesthesia. A systematic search for empirical scientific evidence came up with two articles which support the recommended change in practice.Lumbar Puncture Procedure Recommendation for Newborns.

Recommendation for Revision

This paper recommends a revision in the practice in the above NICU from not using local anesthesia to using it, together with the existing adjunctive measures such as administration of sucrose. The rationale is that current evidence supports the use of local anesthesia when performing a LP on a newborn. Goldman (2019) states that a combination of lidocaine and prilocaine or 1% lidocaine (or both of the preparations) are recommended, since their use is linked to better outcomes.

The two studies identified are those by Fallah et al. (2016) and Caltagirone et al. (2018). The former study is found in the Cochrane Central Register of Controlled Trials (CENTRAL) and the later is found in both CENTRAL and PubMed.Lumbar Puncture Procedure Recommendation for Newborns.

Purpose of Study

The objective or purpose of the study by Caltagirone et al. (2018) was to compare needle-free jet-injection (J-Tip) anesthesia containing 1% lidocaine with topical anesthetic cream in LPs for newborns. This is commendable because the problem with needle injections has been that they themselves cause pain even before the procedure itself. The purpose of study for Fallah et al. (2016) on the other hand was to assess the efficacy and safe use of intravenous fentanyl in pain prevention during LP in neonates. This approach would result in a more systemic effect of the anesthetic, but if safety and efficacy are demonstrated would be a welcome development.

Study Design

The study design for both studies was a randomized controlled trial or RCT, with that by Caltagirone et al. (2018) being double-blind. According to Winoma State University (2020), RCTs offer one of the highest levels of evidence (LOE) for practice change at level II just below systematic reviews. Caltagirone et al (2018) gave 1% lidocaine in a J-Tip syringe and placebo topical anesthetic (TA) to one group of the study sample, and normal saline (N/S) of a similar amount in a similar J-Tip syringe and real TA to the other group. Fallah et al. (2016) gave one group in the RCT 2 mcg/ kg of fentanyl diluted to 0.2ml intravenously (i.v.), and 0.2ml of N/S to the control group.Lumbar Puncture Procedure Recommendation for Newborns.

Description of the Sample

The sample in Caltagirone et al. (2018) was a computer randomized sample of 66 newborns between 0-4 months (n=66). Of these, 32 newborns were assigned to the J-Tip group and 34 to the TA group (EMLA cream with 2.5% lidocaine and 2.5% prilocaine). In the sample by Fallah et al. (2016), 23 newborns were assigned to the fentanyl group while 22 were assigned to the plain N/S group (control). Their total random sample was 45 newborns (n=45). The sampling in both studies was done well. However, it cannot escape the attention of a keen observer that these samples were way too small for watertight validity and reliability. A larger sample in both studies would have been more desirable.Lumbar Puncture Procedure Recommendation for Newborns.

Results

Caltagirone et al. (2018) found that LPs done with needleless J-Tip were twice as likely to be successful in comparison to those done using topical anesthetic alone, the number of previous LPs done and level of training of the clinicians remaining constant. Fallah et al. (2016) on their part found that pain reduction in the fentanyl group was better (39.1%) compared to 4.5% in the control group.

How the Results are Relevant to the Recommended Change in Practice

Both of the studies clearly demonstrate that anesthesia is needed for the LP procedure in newborns for their comfort and immobility. It leads to greater success with the procedure and better patient outcomes. Anesthetic administration by the non-needle J-Tip method is effective as it eliminates the pain caused by the pricking of the newborn before the procedure. Intravenous fentanyl is also a viable choice as it is also safe and effective (Caltagirone et al., 2018; Fallah et al. (2016). Additionally, Caltagirone et al. (2018) also agree with the current practice in the NICU of giving adjunctive oral sucrose in addition to the anesthesia.Lumbar Puncture Procedure Recommendation for Newborns.

Conclusion

From the evidence available, it is recommended that a change in practice be implemented from not using anesthetic to using the same before performing lumbar puncture in newborns. The rationale is that newborns suffer a lot of pain during the procedure and experience significant discomfort making them unable to be immobile. The lack of anesthesia therefore reduces the chances of success of the procedure. Two studies that are RCTs have supported this recommendation (Caltagirone et al., 2018; Fallah et al., 2016). A suitable anesthetic should therefore be used henceforth in conjunction with the administration of oral sucrose.                     Lumbar Puncture Procedure Recommendation for Newborns.

Please follow the rubric to answer everything required in the paper.

• VERY IMPORTANT: Critique of each research study:

 The critique of each of the research studies (total of 2 studies to be located using Cochrane, cinahl or pubmedplease) should include: purpose of the study, study design, description of study sample, results of study, description of how results relevant to the recommended revision.

Assessment of an Advanced Practice Procedure

The purpose of this assignment is for the student to identify and review a procedure that NNPs (and/or neonatologists) perform in their NICU where they work as an RN and suggest improvements to the procedure based on the most current evidence for practice (i.e. research studies).

Steps in the process:

1. Identify a procedure of interest Lumbar Puncture
2. Identify the existing policy for the procedure that is used by NNPs and neonatologists in the student’s NICU. My current policy does not use any type of pain medication like lidocaine when performing a Lumbar puncture on infant and only gives sucrose (sugar water with pacifier dips).
3. Explore the medical literature to identify ways that the procedure could be improved/updated (with the result of improved patient care/safety).

I need literature that is no more than 5 years old the oldest it can be in 2015. The one specific recommendation I want to change in my policy is for lidocaine or analgesia for pain during the lumbar procedure

4. Make ONESPECIFIC recommendation for policy change for the procedure with support from the current medical literature (two research studies published within the past 5 years that BOTH support the student’s recommendation).An example of a research study is a randomized controlled trial.Do not use None of the following are research studies: quality improvement reports, clinical guidelines/bundles, reports of evidence-based practice projects, meta-analyses.A major part of your grade for this assignment is your ability to identify current research, critique the research, and make an informed recommendation about the need for procedure revision. Because you are being evaluated, you may not ask your instructor to preview your research studies for appropriateness. If you are unclear on what constitutes a research study, refer back to your research text book from N5366.

Assignment Rubric

Lumbar Puncture Procedure Recommendation for Newborns.