Stress During LP and Performance

Written by Clay Smith

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Greater operator stress while performing a lumbar puncture (LP) was associated with lower patient confidence and greater odds of post dural puncture headache (PDPH).

Why does this matter?
Gaining skill in procedures is stressful.  Real people feel real pain and may suffer real sequelae.  Stress causes, "reduced working memory, decreased psychomotor performance, and impaired performance."  How does operator stress impact LP performance and patient confidence?

Does LP stress you out?
This was a multi-center cross sectional study of physicians with varying LP experience, all supervised or assisted by the same attending physician.  Understandably, those with the highest stress level were the novices.  Novices had more failed procedures.  Patient-rated pain was no different among novices, intermediates, and experts.  Patients had decreased confidence in those with the highest stress level scores.  Physicians with high heart rate during the procedure had greater odds of PDPH.  The authors suggested doing more simulation to reduce procedural stress for novices.

Source
Opinion and Special Articles: Stress when performing the first lumbar puncture may compromise patient safety.  Neurology. 2018 May 22;90(21):981-987. doi: 10.1212/WNL.0000000000005556.
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Reviewed by Thomas Davis

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