The stylet-out LP technique was performed in 29 percent of these first LP attempts. For all children, the stylet-in technique demonstrated an adjusted OR of 1.8 (95% CI; 1.3–2.7) for failure. For kids age 3 months or younger, failure was significantly associated with stylet in, with an OR of 1.4 (95% CI; 1.02–2.0), suggesting that stylet out improves LP success.
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ACEP Now: Vol 37 – No 10 – October 2018Summary: After insertion of the LP needle through the epidermis and subcutaneous tissue with the stylet in, advancing stylet out appears to improve LP success in children.
Dr. Jones is assistant professor of pediatric emergency medicine at the University of Kentucky in Lexington.
Dr. Cantor is professor of emergency medicine and pediatrics, director of the pediatric emergency department, and medical director of the Central New York Regional Poison Control Center at Upstate Medical University in Syracuse, New York.
References
- McLennan TA. Removal of the stylet during the performance of lumbar puncture. Can Med Assoc J. 1962;86(12):544.
- Baxter AL, Fisher RG, Burke BL, et al. Local anesthetic and stylet styles: factors associated with resident lumbar puncture success. Pediatrics. 2006;117(3):876-881.
- Nigrovic LE, Kuppermann N, Neuman MI. Risk factors for traumatic or unsuccessful lumbar punctures in children. Ann Emerg Med. 2007;49(6):762-771.
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