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To the Editor: In their Rational Clinical Examination review, Dr Straus and colleagues¹ comment that preparation of the skin should be performed in circular motion starting from the point of proposed lumbar puncture in an outward spiral. I am not aware of any clinical trial that has addressed the validity of this teaching. When I was introduced to the spiral technique during medical school in the 1970s, I was told that the concept was to avoid spreading organisms from the unprepped to the prepped skin. Studies have evaluated the use of povidone-iodine paint allowed to dry, but they have not specified a spiral technique.^2-3 In the absence of supporting evidence, I believe that the spiral approach to skin preparation should be abandoned.

Financial Disclosures: None reported.

Jeffrey L. Kaufman, MD
kaufman@massmed.org
Vascular Services of Western New England
Springfield, Mass

1. Straus SE, Thorpe KE, Holroyd-Leduc J. How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis? JAMA. 2006;296:2012-2022. FREE FULL TEXT 2. Ellenhorn JD, Smith DD, Schwarz RE, et al. Paint-only is equivalent to scrub-and-paint in preoperative preparation of abdominal surgery sites. J Am Coll Surg. 2005;201:737-741. FULL TEXT | ISI | PUBMED 3. Zdeblick TA, Lederman MM, Jacobs MR, et al. Preoperative use of povidone-iodine: a prospective, randomized study. Clin Orthop Relat Res. 1986;213:211-215. PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297:810.

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