Shafer Shawna, Rooney Deborah, Schumacher Robert, House Joseph B
a Division of Neonatal/Perinatal Medicine, University of Michigan , Ann Arbor , Michigan , USA.
Teach Learn Med. 2015;27(2):205-7. doi: 10.1080/10401334.2014.979185.
Pediatric residents commonly perform lumbar punctures during their clinical training. The objective of this study was to assess residents' rate of nontraumatic lumbar punctures, examine the adequacy of samples, and implement proper documentation of the procedure in an academic Level 4 Neonatal Intensive Care Unit. We hypothesize that traumatic taps are common and that documentation of the procedure is poor.
A retrospective chart review was done of infants admitted to the neonatal intensive care unit from January 2011 to November 2011 who underwent a lumbar puncture. Procedure notes were evaluated for completion of proper documentation, the lab specimen was assessed for red blood cell count less than 1,000 cells/mm(3), and individuals were assessed for their ability to obtain a cerebrospinal fluid sample to send to the lab for analysis (i.e., sample of adequate volume and not clotted) and the total number of attempts to obtain a sample. A total of 184 charts were reviewed. Procedure notes were incomplete (58%) and lacked pertinent details. Eight percent of samples obtained had no record of the procedure being preformed. There was inadequate sample acquisition in 23% of the lumbar punctures. More than three attempts were noted in 14% of lumbar punctures performed. Many specimens contained very high red blood cell counts. Seventy-five percent of lumbar punctures with full documentation (n = 60), resulted in cerebrospinal fluid with more than 1,000 red blood cells/mm(3) and 55% of underdocumented lumbar punctures resulted in cerebrospinal fluid with more than 1,000 red blood cells/mm(3) (n = 71).
We found that poorly documented lumbar punctures are common and the ability of residents to obtain satisfactory cerebrospinal fluid is low. The inability of residents to consistently perform nontraumatic lumbar punctures is likely a common phenomenon. New educational methods and evaluation criteria must be developed to address this gap in resident education.
儿科住院医师在临床培训期间经常进行腰椎穿刺。本研究的目的是评估住院医师进行非创伤性腰椎穿刺的比例，检查样本的充分性，并在学术性四级新生儿重症监护病房实施该操作的适当记录。我们假设创伤性穿刺很常见且该操作的记录不佳。
对2011年1月至2011年11月入住新生儿重症监护病房并接受腰椎穿刺的婴儿进行了回顾性病历审查。评估操作记录是否完成了适当的记录，评估实验室标本的红细胞计数是否低于1000个细胞/mm³，并评估个人获取脑脊液样本并送至实验室进行分析的能力（即，样本量足够且未凝固）以及获取样本的总尝试次数。共审查了184份病历。操作记录不完整（58%）且缺乏相关细节。8%的获取样本没有操作记录。23%的腰椎穿刺样本采集不足。14%的腰椎穿刺操作尝试次数超过三次。许多标本的红细胞计数非常高。有完整记录的腰椎穿刺中有75%（n = 60），脑脊液中的红细胞计数超过1000个/mm³，记录不完整的腰椎穿刺中有55%（n = 71），脑脊液中的红细胞计数超过1000个/mm³。
我们发现腰椎穿刺记录不佳很常见，住院医师获取满意脑脊液的能力较低。住院医师不能始终进行非创伤性腰椎穿刺可能是一种普遍现象。必须开发新的教育方法和评估标准来弥补住院医师教育中的这一差距。
