Local Anesthetic and Stylet Styles: Factors Associated With Resident Lumbar Puncture Success
- 1 March 2006
- journal article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 117 (3), 876-881
- https://doi.org/10.1542/peds.2005-0519
Abstract
OBJECTIVE. To assess the effects of procedural techniques, local anesthetic use, and postgraduate training level on lumbar puncture (LP) success rates.METHODS. In this prospective observational study, medical students and residents (“trainees”) reported techniques used for infant LPs in an urban teaching emergency department. Data on postgraduate year, patient position, draping, total and trainee numbers of attempts, local anesthetic use, and timing of stylet removal were collected. Logistic regression analysis was used to identify predictors of successful LP, with success defined as the trainee obtaining cerebrospinal fluid with 12 weeks of age than among younger infants (odds ratio [OR]: 3.1; 95% confidence interval [CI]: 1.2–8.5). Controlling for attempts and age, LPs performed with local anesthetic were twice as likely to be successful (OR: 2.2; 95% CI: 1.04–4.6). For infants ≤12 weeks of age, early stylet removal improved success rates (OR: 2.4; 95% CI: 1.1–5.2). Position, drape use, and year of training were not significant predictors of success.CONCLUSIONS. Patient age, use of local anesthetic, and trainee stylet techniques were associated with LP success rates. This offers an additional rationale for pain control. Predictors identified in this study should be considered in the training of physicians, to maximize their success with this important procedure.Keywords
This publication has 13 references indexed in Scilit:
- Pain, Position, and Stylet StylesPediatric Emergency Care, 2004
- Intraspinal Epidermoid Tumors Caused by Lumbar PunctureArchives of Neurology, 1986
- Epidermoid spinal cord tumour after lumbar puncture.Archives of Disease in Childhood, 1985
- Incidence and Effect of Traumatic Lumbar Puncture in the NeonateDevelopmental Medicine and Child Neurology, 1979
- LUMBAR PUNCTURE AND EPIDERMOID TUMOURSThe Lancet, 1977
- Iatrogenic intraspinal epidermoid tumorsJAMA, 1977
- Epidermoid spinal cord tumors and previous lumbar puncturesThe Journal of Pediatrics, 1972
- Lumbar puncture in the neonate: A simplified techniqueThe Journal of Pediatrics, 1971
- SKIN FRAGMENTS REMOVED BY INJECTION NEEDLESThe Lancet, 1958
- INTRASPINAL EPIDERMOID TUMOURS (CHOLESTEATOMAS) IN PATIENTS TREATED FOR TUBERCULOUS MENINGITISThe Lancet, 1956