Local anesthetic and stylet styles: factors associated with resident lumbar puncture success.

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 <1000 red blood cells per mm3. RESULTS:We collected data on 428 (72%) of 594 infant LPs performed during the study period. Of 377 performed by trainees, 279 (74%) were successful. Local anesthesia was used for 280 (74%), and 225 (60%) were performed with early stylet removal. Controlling for the total number of attempts, LPs were 3 times more likely to be successful among infants >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 < or =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.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Baxter AL,Fisher RG,Burke BL,Goldblatt SS,Isaacman DJ,Lawson ML

doi

10.1542/peds.2005-0519

subject

Has Abstract

pub_date

2006-03-01 00:00:00

pages

876-81

issue

3

eissn

0031-4005

issn

1098-4275

pii

117/3/876

journal_volume

117

pub_type

杂志文章
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    更新日期:1997-02-01 00:00:00

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    authors: Fekkes M,Pijpers FI,Fredriks AM,Vogels T,Verloove-Vanhorick SP

    更新日期:2006-05-01 00:00:00

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    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Adams LA,Rickert VI

    更新日期:1989-11-01 00:00:00

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    authors: Tauman R,O'Brien LM,Ivanenko A,Gozal D

    更新日期:2005-07-01 00:00:00

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    journal_title:Pediatrics

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    authors: Gilliland FD

    更新日期:2009-03-01 00:00:00

  • Administration of ondansetron is associated with lethal outcome.

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2009-2795

    authors: Gener B,Burns JM,Griffin S,Boyer EW

    更新日期:2010-06-01 00:00:00

  • Effects of polychlorinated biphenyl/dioxin exposure and feeding type on infants' mental and psychomotor development.

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Koopman-Esseboom C,Weisglas-Kuperus N,de Ridder MA,Van der Paauw CG,Tuinstra LG,Sauer PJ

    更新日期:1996-05-01 00:00:00

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Harshfield GA,Alpert BS,Pulliam DA,Somes GW,Wilson DK

    更新日期:1994-08-01 00:00:00

  • Looking beyond the physical injury: posttraumatic stress disorder in children and parents after pediatric traffic injury.

    abstract:BACKGROUND:Traffic crashes are the leading health threat to children in the United States, resulting in nearly 1 million injuries annually. The psychological consequences of these injuries are primarily unknown. The aims of this study were to estimate the prevalence of posttraumatic stress disorder (PTSD) in traffic-in...

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    pub_type: 杂志文章

    doi:10.1542/peds.104.6.1293

    authors: de Vries AP,Kassam-Adams N,Cnaan A,Sherman-Slate E,Gallagher PR,Winston FK

    更新日期:1999-12-01 00:00:00

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.108.2.e30

    authors: Slap G,Goodman E,Huang B

    更新日期:2001-08-01 00:00:00

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Horwood SP,Boyle MH,Torrance GW,Sinclair JC

    更新日期:1982-05-01 00:00:00

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    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Sumarmo,Talogo W,Asrin A,Isnuhandojo B,Sahudi A

    更新日期:1982-01-01 00:00:00

  • Age Limit of Pediatrics.

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    pub_type: 杂志文章

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Bach V,Bouferrache B,Kremp O,Maingourd Y,Libert JP

    更新日期:1994-05-01 00:00:00

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    pub_type: 杂志文章

    doi:10.1542/peds.2004-0457

    authors: Wathen JE,MacKenzie T,Bothner JP

    更新日期:2004-11-01 00:00:00

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.108.4.e62

    authors: Lahiri T,Waltz DA

    更新日期:2001-10-01 00:00:00

  • Surfactant replacement therapy for respiratory distress syndrome. American Academy of Pediatrics. Committee on Fetus and Newborn.

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    pub_type: 指南,杂志文章,实务指引

    doi:

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    更新日期:1999-03-01 00:00:00

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    journal_title:Pediatrics

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1542/peds.109.2.e20

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    更新日期:2002-02-01 00:00:00

  • Ganglioneuroblastoma and fetal hydantoin-alcohol syndromes.

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Seeler RA,Israel JN,Royal JE,Kaye CI,Rao S,Abulaban M

    更新日期:1979-04-01 00:00:00

  • From the American Academy of Pediatrics: Technical report--Tobacco as a substance of abuse.

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2009-2121

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.114.1.73

    authors: Miele E,Simeone D,Marino A,Greco L,Auricchio R,Novek SJ,Staiano A

    更新日期:2004-07-01 00:00:00

  • Pituitary gland gumma in congenital syphilis after failed maternal treatment: a case report.

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    doi:10.1542/peds.104.1.e4

    authors: Benzick AE,Wirthwein DP,Weinberg A,Wendel GD Jr,Alsaadi R,Leos NK,Zeray F,Sánchez PJ

    更新日期:1999-07-01 00:00:00

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2012-1665

    authors: Saito JM,Yan Y,Evashwick TW,Warner BW,Tarr PI

    更新日期:2013-01-01 00:00:00

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

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    更新日期:2000-11-01 00:00:00

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    pub_type: 杂志文章

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    doi:

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    doi:

    authors: Jaffe M,Tal Y,Hadad B,Tirosh E,Tamir A

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    pub_type: 杂志文章

    doi:

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