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To the Editor: We are concerned about the recommendation that Dr Straus and colleagues¹ made in the Rational Clinical Examination article on lumbar punctures to reinsert the stylet upon completion of a lumbar puncture. This is a difficult maneuver with a high potential for a sharps injury because reinsertion requires the use of one hand to steady the hollow needle while introducing the highly flexible stylet through the needle hub.

We believe this also violates the "Needlestick Safety and Prevention Act"² because the enforcement instructions for this law as promulgated by the Occupational Safety and Health Administration³ require the employer to institute engineering and work practice controls as the primary means of reducing occupational exposure to the lowest possible extent.

In the context of spinal anesthesia, not reinserting the stylet is consistent with the description of anesthesiologist practices by Strupp et al⁴ because the outward flow of anesthetic should theoretically . . . [Full Text of this Article]

Stephen Piwinski, MD, MOH
piwinski@UTHSCSA.edu
Department of Medicine

Wendell Johnson, DO; Michelle Kawasaki, MD
Department of Anesthesiology
University of Texas Health Science Center
San Antonio

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