Too many attempts at a spinal tap?

Nurses Safety

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I just started working on a unit. There was a patient (not mine directly)

that needed to have a lumbar puncture. Long story short, atleast 5 attempts were made, all by residents, with no success. The parents of this patient were not informed of all these attempts, and the patient only being one day old could obviously not speak for himself. Is this an acceptable practice, and would you speak to someone about it. It just eats me up inside everytime I think about. I feel that if the residents didnt get it on the first try then the attending should of been called in. I am planning on saying something to my manager but I want to see what you guys think as well. Thanks for the help.

Specializes in Neuro, HIV/AIDS, Mother/Baby.

Thank You for your support everyone. I am going to talk to my manager when I go in this week to make sure that there is a policy in place so that this doesnt happen again. Thank you again.

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Specializes in ER.

I agree with you Moe. when they went in fort he third tap I would have been concerned, when they went in for the fourth tap I think that would be the point where someone needed to stand up for the baby, and demand that a more experienced person be called to the unit. No more trying- either be able to get it done and over or get out of the room.

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What are the facility policies regarding neonatal LP's? Prior to making an issue, obtain as much information as possible regarding the facility policy and guidelines regarding the procedure and residents. It looks like you intend to do this.

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I'm not sure what you disagree with. If it is a teaching hospital, then a resident certainly is allowed to (attempt to) perform a spinal tap on a neonate. This is true whether or not you agree that it should be.

Did I say it was the best practice for the patient? Did I say I wouldn't be fuming if it were my child or even my patient? Did I say had I been present that I wouldn't have told the anesthesia residents that they should maybe either call an attending or check the spine to see what the problem was? I never said "Well, they're MDs, let them just poke away blindly".

Was an attending present and/or available at the time? Was it a STAT order? Was there a known anomaly of the spine? What year residents were they?

I'm a little hesitant to flip out and judge a case that we know little about (it wasn't even the OPs pt).

We seem to disagree on whether it is a reportable incident, that was what I was referring to. I feel the incident should be reported, you do not seem to feel that it should be reported as you did not recommend it in your post.

Obviously we do not know the whole story but what we do know is that a baby was poked 5 times for an LP. I feel this is unacceptable and should be reported. That way all the facts can come to light and if any lessons or other ramifications come towards the residents way, so be it, it will likely make them better drs and improve future pt care.

Hope this helps clear up what I meant when I said I disagree with the previous poster.

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You get more than one or two tries on procedures and you're allowed to make mistakes. Get over yourself.

Actually, as a student or new nurse, If I tried a procedure 5 times to get it right, I would likely be written up. Reason? It isn't fair to the pt and if you don't get it on the second try, the 3rd, 4th and 5th tries are probably not going to be successful either. This has nothing to do with being allowed to make mistakes, it has everything to do with knowing when enough is enough.

We are expected to take what we have learned on the one or two failed attempts, think about what we could have done better and try again when the opportunity comes up for a different pt.

For example, we have a firm 2 stick rule for IV starts. No one person is allowed to try more than twice and after two sticks on one pt, an expert is called in from the hospital IV team.

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If this were something that were acceptable, I doubt Silas2642 would be so concerned that you might report it.

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Specializes in NICU, PICU, educator.

I work in a NICU in a large teaching hospital. In our unit, if a resident ever stuck a kid more than 2x for an LP and didn't call the fellow or attending, their ass would be chewed off. And we wouldn't let that happen.

Also, the baby should have been given a local before the start of that LP...sugar water ain't gonna cut it. and, was there informed consent. We have to have informed and written consent before we do LP's in our unit.

You need to take this up with your manager and the head docs.

And as for the troll Silas....boy, I hope you aren't at our hospital, you sound like a really loveable sort. :uhoh3:

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it's really scary what's out there, isn't it?

leslie

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Specializes in Maternal - Child Health.

i was working in nicu one night when a resident was doing an lp on a preemie for r/o sepsis. another nurse was assisting him, but had her hands full when he asked for a syringe. before getting it for him, i asked why he needed it. he stated that the csf was dripping out too slowly, and he needed a syringe to pull it out! needless to say, i did not get him the syringe, but did get the attending who took over the tap and sent the resident packing.

and there are posters here who think that nurses should not question residents or advocate for patients!

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Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.
i was working in nicu one night when a resident was doing an lp on a preemie for r/o sepsis. another nurse was assisting him, but had her hands full when he asked for a syringe. before getting it for him, i asked why he needed it. he stated that the csf was dripping out too slowly, and he needed a syringe to pull it out! needless to say, i did not get him the syringe, but did get the attending who took over the tap and sent the resident packing.

and there are posters here who think that nurses should not question residents or advocate for patients!

:yeah: :yeah: :yeah:

exactly.

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i was working in nicu one night when a resident was doing an lp on a preemie for r/o sepsis. another nurse was assisting him, but had her hands full when he asked for a syringe. before getting it for him, i asked why he needed it. he stated that the csf was dripping out too slowly, and he needed a syringe to pull it out! needless to say, i did not get him the syringe, but did get the attending who took over the tap and sent the resident packing.

wow that is scary to hear. peope have terrible side effects often as it is from a properly done lp.

i disagree as many people do with the idea of not being concerned since this wasn't the ops patient. if you see the wrong med being given to a patient or know the patient is allergic to the medicine they are about to receive would you keep quiet? i would certainly hope not. also as others have stated, since babies can't advocate for themselves, nurses need to do it for them just like they need to for adults who are incompetent or are afraid of "making waves".

i have grown up receiving my medical care at a local teaching hospital. i know i have the right to refuse to allow a med student/resident etc to take part in my care but i allow them to depending on the procedure and sick i am. i realize everyone needs to learn and you can't learn unless by doing but too many patients either don't know they can refuse treatment by a med student/ resident without jeporadizing the care they will receive from the attending or are bullied into receiving care by a student.

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Specializes in ER-Adult and Peds, also ICU.

This makes steam come out of my ears. I strongly advocate for my patients. I was in a similar situation except the attending was attempting the tap. I made her stop after a couple of tries andI forced her to give the neonate breaks. I just had my son by c-section and the resident spent 15 minutes digging into my spinal CORD before the attending took over and got it. I now have spinal cord nerve root damage, and as a result I am in almost constant pain. The only treatment is narcotics. Try working on tylenol and ibuprofen for 12 hours going home and finally taking your PRESCRIBED pain medication, and still convince your agency that you would not take anything that would affect your ability to do your job at work. This resident left me with permenant damage, and I can't sue. It was a teaching hospital. And although residents have MD after their name does not make them experienced enough for some things. If they were all grown up we would not have to correct orders and hold their little hands. In the ER where I was working it was a regular thing to have to train the residents, we were a Level 1 and they could not find their way out of a paper bag. I don't care what letters you have after your name, either you can do the job or not and know your limitations.:trout:

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