Zhang Yi C, Chandler Alexander J, Kagetsu Nolan J
Department of Radiology, St Luke's-Roosevelt Hospital, 1000 10th Ave Rm 4C-12, New York, NY 10019.
Department of Radiology, Beth Israel Medical Center, New York, NY.
Acad Radiol. 2014 May;21(5):612-6. doi: 10.1016/j.acra.2014.01.021.
To assess technical compliance among neuroradiology attendings and fellows to standard guidelines for lumbar puncture and myelography to minimize procedural complications such as iatrogenic meningitis and spinal headache.
We surveyed academic neuroradiology attendings and fellows in the e-mail directory of the Association of Program Directors in Radiology. We queried use of face masks, use of noncutting needles, and dural puncture practices. All data were collected anonymously.
A total of 110 survey responses were received: 75 from neuroradiology attendings and 34 from fellows, which represents a 14% response rate from a total of 239 fellows. Forty-seven out of 101 (47%) neuroradiologists do not always wear a face mask during myelograms, and 50 out of 105(48%) neuroradiologists do not always wear a face mask during lumbar punctures, placing patients at risk for iatrogenic meningitis. Ninety-six out of 106 neuroradiologists (91%) use the Quincke cutting needle by default, compared to only 17 out of 109 neuroradiologists (16%) who have ever used noncutting needles proven to reduce spinal headache. Duration of postprocedure bed rest does not influence incidence of spinal headache and may subject patients to unnecessary monitoring. Only 15 out of 109 (14%) neuroradiologists in our study do not prescribe bed rest. There was no statistically significant difference in practice between attendings and fellows.
Iatrogenic meningitis and spinal headache are preventable complications of dural puncture that neuroradiologists can minimize by conforming to procedural guidelines. Wearing face masks and using noncutting spinal needles will reduce patient morbidity and lower hospitalization costs associated with procedural complications.
评估神经放射科主治医生和住院医生对腰椎穿刺和脊髓造影标准指南的技术依从性，以尽量减少诸如医源性脑膜炎和脊柱头痛等操作并发症。
我们在放射学项目主任协会的电子邮件目录中对学术性神经放射科主治医生和住院医生进行了调查。我们询问了口罩的使用、无切割针的使用以及硬脊膜穿刺操作。所有数据均匿名收集。
共收到110份调查问卷回复：75份来自神经放射科主治医生，34份来自住院医生，这代表了239名住院医生中14%的回复率。101名神经放射科医生中有47名（47%）在脊髓造影期间并非总是佩戴口罩，105名神经放射科医生中有50名（48%）在腰椎穿刺期间并非总是佩戴口罩，这使患者面临医源性脑膜炎的风险。106名神经放射科医生中有96名（91%）默认使用奎克切割针，相比之下，109名神经放射科医生中只有17名（16%）曾使用过经证实可减少脊柱头痛的无切割针。术后卧床休息的时间并不影响脊柱头痛的发生率，且可能使患者接受不必要的监测。在我们的研究中，109名神经放射科医生中只有15名（14%）不开具卧床休息医嘱。主治医生和住院医生在操作方面没有统计学上的显著差异。
医源性脑膜炎和脊柱头痛是硬脊膜穿刺可预防的并发症，神经放射科医生可通过遵循操作指南将其降至最低。佩戴口罩和使用无切割脊髓针将降低患者发病率，并降低与操作并发症相关的住院费用。
