TRACKING AND MANAGEMENT OF POST-DURAL PUNCTURE HEADACHE
Creators: name: Velasquez, Joseph E.
Publisher: name: Zenodo
Year: 2015

description: Post-dural puncture headache (PDPH) can occur with neuraxial procedures commonly used in obstetric anesthesia and analgesia. Both spinal and epidural analgesia are performed using special needles that are designed to cause minimal or no injury to the dural membrane surrounding lumbar neuronal structures. Occasionally, disruptions to this protective membrane can result in a loss of the cerebral spinal fluid (CSF) surrounding the brain and spinal cord. A decreased volume of lost CSF can result in significant symptoms (e.g., severe headache, nausea, vomiting, visual/ auditory disturbances). Most debilitating is the impairment for parturients to care for themselves or their newborn. Relief of symptoms can be obtained through various interventions depending on the degree of symptom severity. Limited activity, bedrest in a supine position with the head-of-bed low, analgesics, caffeinated beverages and fluids are often successful to minimize discomfort. However, marked debilitation is treated with an autologous epidural blood patch (AEBP) to alleviate symptoms; AEBP demonstrates high rates of efficacy and patient satisfaction. The purpose of this Doctor of Nursing Practicew project was to implement a uniform reporting and follow-up system for known unintentional dural punctures (UDPs) and PDPH. Such a system would guide clinicians to identify and track incidents of PDPH more effectively, thereby facilitating ongoing efforts to improve management of these potentially serious events. iv This quality improvement project focused on implementation of a systematic surveillance and reporting system for suspected PDPH cases. Complaints of headache, UDPs, confirmed PDPH cases, treatment strategies, and AEBP procedures were prospectively tracked. Additionally tracked were descriptions of symptom resolution, whether additional evaluation, intervention, or patient referral was needed, and whether cases resulted in hospital readmission. Hospital staff provided daily surveillance, with monthly and quarterly reporting to anesthesia/obstetric staff and primary stakeholders. Headache, UDPs, and AEBP incidents occurring in 2014 were compared to annual Quality Assurance data dating back to 2010. Analysis was via descriptive statistics. A total of 14 cases were identified as confirmed or potential for PDPH during surveillance (January 1 through December 31, 2014). Nine cases were related to epidurals and five to spinal anesthetics for cesarean section. There were a total of 6 UDPs among the nine epidural cases. A total of nine AEBPs were performed (4 spinals; 5 epidurals). Two patients were readmitted to the hospital. The median patient age was 28 years. The results of this project verified low rates of PDPH at the facility and appropriate use of evidence-based practices in their management. Because PDPH presents clinicians with a problem that must be resolved quickly, anesthesia practices that serve a high number of parturients should adopt some form of tracking and management reporting methods to document positively identified cases, ensure subsequent reevaluation, and ensure patient needs are addressed.