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[Do paediatricians perform lumbar puncture correctly? Review of recommendations and analysis the technique in Spain]
P Storch De Gracia Calvo1, M De La Torre Espí, M J Martín Díaz
1Servicio de Urgencias, Hospital Infantil Universitario Niño Jesús, Madrid, España. pstorchdegracia.hnjs@salud.madrid.org
Insights
Paediatricians often incorrectly position needles during lumbar punctures (LP) and use inappropriate needles for newborns. Paediatric residents demonstrate better adherence to recommended LP techniques.
Area of Science:
- Pediatric Medicine
- Medical Procedures
- Patient Safety
Context:
- Lumbar puncture (LP) is a frequent pediatric procedure.
- Proper technique is crucial to minimize complications.
- Adherence to established guidelines ensures procedural safety and efficacy.
Purpose:
- To evaluate adherence to current lumbar puncture (LP) technique recommendations among Spanish pediatricians and residents.
- To identify potential deviations from best practices in pediatric LP.
Summary:
- A cross-sectional study analyzed 206 questionnaires on lumbar puncture (LP) techniques.
- Findings indicate frequent incorrect needle bevel orientation and inappropriate use of 'butterfly' needles in neonates by experienced pediatricians.
- Paediatric residents showed higher compliance with recommended LP procedures.
Impact:
- Highlights critical areas for improvement in pediatric lumbar puncture (LP) training and practice.
- Emphasizes the need for continuous education to ensure optimal patient outcomes.
- Identifies a knowledge gap that may contribute to LP-related complications.
Introduction:
Lumbar puncture (LP) is a commonly performed procedure in paediatrics. Performing this technique properly can avoid the most common associated complications.
Objective:
To assess whether paediatricians and paediatric residents in Spain follow current recommendations for the LP technique.
Material And Methods:
A cross-sectional study was conducted by sending a questionnaire by mail through the Spanish Society of Paediatric Emergencies, collecting demographic information and responses to multiple choice questions about LP technique.
Results:
A total of 206 questionnaires were analysed, of which 143 (69.5%) were answered by paediatricians, and 63 (30.5%) by paediatric residents. The majority (128; 62.1%) of physicians did not allow parents to be present during LP, 198 (96.1%) routinely use analgesia and sedation; 84 (42%) only used local anaesthesia. The majority of respondents used standard Quincke needles (126; 62.7%). The bevel was correctly positioned when puncturing the dura mater by 22 residents (36.1%) and 21 paediatricians (15.1%), a variation that was statistically significant (P=.001). For neonatal lumbar punctures, 63 paediatricians (46%) and 19 paediatric residents used a butterfly needle which did not contain a stylet, and this difference was also statistically significant (P=.035). Of those surveyed, 190 (92.2%) re-inserted the stylet when re-orientating the needle, and 186 (93%) re-oriented this when removing it. The recommendation of bed rest was made by 195 (94.7%) physicians.
Conclusions:
The majority of paediatricians orient the bevel wrongly when inserting the needle during LP, and still use "butterfly" needles in newborns, despite warnings to the contrary. Paediatric residents and less experienced paediatricians follow the recommendations more frequently.
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