About pencil point needle introduction

Numerous studies and meta-analyses have shown that the pencil-point needle is less traumatic to the dura and has a lower risk of post dural puncture headache or persistent dural defect. For regular diagnostic lumbar punctures, the literature is clear that the smaller gauge atraumatic pencil-point needles would usually be the preferred type of needle. While many anesthesia departments have adopted the use of the atraumatic type of needles, the routine use in emergency departments, outpatient and inpatient settings is not yet standard of care across the country. “We have used atraumatic pencil-point needles in inpatient and outpatient settings for lumbar punctures for several years in our institution” says Wouter Schievink, MD, neurosurgeon at Cedars-Sinai Medical Center in Los Angeles, a center that treats many iatrogenic and spontaneous spinal CSF leaks.

Marcel Maya, MD, interventional neuroradiologist of Cedars-Sinai Medical Center offered his perspective regarding needle use for the various types of myelography done at a high frequency at their institution. For injection of contrast for conventional myelography (with subsequent imaging), contrast need not be injected rapidly, so a smaller gauge pencil-point needle can be used. They currently have atraumatic pencil-point needles available for conventional myelography. In some other types of myelography, such as dynamic CT myelography and digital subtraction myelography (DSM), the contrast must be injected rapidly under pressure to achieve a higher diagnostic yield, so they have found that smaller gauge pencil-point needles are less suitable. The sharp beveled needles are used for these cases. It is important to keep in mind that this center does a very high volume of myelography and the physicians performing these procedures are highly skilled.

The interventional neuroradiologists at Duke University also treat a large volume of patients with known or suspected spinal CSF leaks. Linda Gray Leithe, MD, reports that small gauge atraumatic pencil-point needles are routinely used for CT myelography in their department.

BBeyond physician experience and needle size and type, patient factors, such as an undiagnosed heritable disorder of connective tissue, gender, spinal anatomy and body weight can influence the risk of post dural puncture CSF leak, but these are not modifiable factors.

The benefit of a diagnostic procedure that includes a lumbar puncture usually outweighs the risk of post dural puncture CSF leak. However, the risk of this complication, along with the associated suffering, morbidity and health care costs, can be reduced with the use of atraumatic pencil-point needles for regular diagnostic lumbar punctures and conventional myelography. More widespread adoption of the routine use of these atraumatic needles should be encouraged where appropriate.

Shenzhen Manners Technology Co.,Ltd is the supplier of some of the world’s famous international companies like Blum Novotest, Komet, Geneva Lab, BTL, etc... We specialize in telescoping parts, needle manufacturing, multi-axis CNC machining, Die casting mold, plastic injection mold, stamping mold, Swiss-type turning, laser cut tubing, tube processing, laser welding and automated assemblies for the medical, endoscopic, arthroscopic, orthopedic, firearms, defense, automotive, and specialty industrial markets.

Please contact us if you need: zhang@sz-manners.com.