Blood epidural catheter

[jeesapeesa]

Hey guys. I swear I'm midline and this has happened to me at least once a shift since I started private practice. Wasn't a problem in residency. We use Perifix epidural kit with polyamide epidural catheter and as I'm threading through the epidural needle there's always blood that just streams down the catheter and I just remove the whole thing and start over (always a level down at nearly the same "line" where the other needle was placed). Is it because I'm really not midline or is it because these catheters are rigid AF.

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[sevoflurane]

Spring wound catheters catheters avoid these problems 99% of the time.

 

[AdmiralChz]

Hey guys. I swear I'm midline and this has happened to me at least once a shift since I started private practice. Wasn't a problem in residency. We use Perifix epidural kit with polyamide epidural catheter and as I'm threading through the epidural needle there's always blood that just streams down the catheter and I just remove the whole thing and start over (always a level down at nearly the same "line" where the other needle was placed). Is it because I'm really not midline or is it because these catheters are rigid AF.

Yeah, we used to see this often in residency with this kit. We would give a small test dose to see if intravascular anyway and just let it rip if no issues

 

[deleted162650]

It's those caths. Ditch 'em for the spring wound variety.

 

[BLADEMDA]

Dilate the space with saline or local especially if you are using stiff epidural catheters.

 

[facted]

Dilate the space with saline or local especially if you are using stiff epidural catheters.

This helps significantly, but still occurs sometimes. I dilate with 5-10ml.

 

[Noyac]

Yep, dilate the space. I hate the spring wound catheters. Too flimsy. Or maybe I’m just a brute.

 

[jeesapeesa]

Thanks everyone. I'll dilate beforehand since it looks like these catheters are not going anywhere anytime soon.

 

[fakin' the funk]

The Brauns go intravascularly. Sometimes you put 'em in, and then they MIGRATE intravascularly later. Just the way it is.

Oh and this is a tautology, but if you get blood you're not midline.

 

[facted]

Oh and this is a tautology, but if you get blood you're not midline.

This is simply not true. I've done loys of epidurals with the braun catheters where I'm CLEARLY midline, nice ligament all the way through, great loss, and then heme in the catheter. Maybe the stiffness of the catheter allows it to veer off the middle when you put it in, but doesn't have to do with where your needle is.

 

[Mman]

Oh and this is a tautology, but if you get blood you're not midline.

Since the epidural space has veins scattered throughout, and the catheter can always go left, right, up, or down while being threaded in, I am not sure what being midline or not on your approach has to do with anything.

We use the Braun periflex catheter kits and I find about 10-15% of them get some degree of blood coming back in the catheter, but usually if I pull the catheter back a bit and flush saline it stops and results in a negative test dose and successful catheter. It's probably only 1-2% of the time I have to pull the catheter and redo it. I only thread forward about 5-6 cm through the needle and then usually pull back to leave about 4-5 cm in the space.

 

[facted]

When I do get heme, I pull back but almost always still get blood back after saline flush. Are you guys giving a test dose anyway? I've just pulled it at that point.

 

[Mman]

When I do get heme, I pull back but almost always still get blood back after saline flush. Are you guys giving a test dose anyway? I've just pulled it at that point.

I guess what do you mean by "get blood back"? If it's straight blood like pulling back on an IV I pull it. If it's fluid with a little bit of a blood tinge to it I will give a test dose. The overwhelming majority of the time I've gotten blood at the end of how far I pushed the catheter in, when I pull it back and flush it I there is no longer frank blood coming back.

 

[Noyac]

I guess what do you mean by "get blood back"? If it's straight blood like pulling back on an IV I pull it. If it's fluid with a little bit of a blood tinge to it I will give a test dose. The overwhelming majority of the time I've gotten blood at the end of how far I pushed the catheter in, when I pull it back and flush it I there is no longer frank blood coming back.

I have seen positive test doses with this technique as well. I do the same, pull back aspirate and see blood tinged aspirate. I give a TD and the heart rate goes up some. Not like the pos TD where it goes up 20bpm and they feel light headed. So I start the pump and all works fine. I believe that you get some uptake through the rent in the vein. I have done this a quite a few occasions. At least once a year I would guess.

 

[thinkorswim]

I agree with everyone that it's the catheter, not you. I have been using these catheters in fellowship and recently had three positive aspirations of frank blood. We used the spring wound catheters in residency where I placed hundreds of epidurals without an issue.

 

[deleted697535]

Left lateral epidurals lessen the risk of this. That's said 2 of my last 10 left laterals had blood in catheter and had to pull them.

But the 200 odd before that, no blood with left lateral.
I can't comment on that type of kit unfortunately

 

[facted]

Left lateral epidurals lessen the risk of this. That's said 2 of my last 10 left laterals had blood in catheter and had to pull them.

But the 200 odd before that, no blood with left lateral.
I can't comment on that type of kit unfortunately

Well, the catheter matters. At my old gig, I had none in 3.5 years. New gig, in a few hundred epidurals it's happened 10 or 15 times though improved by dilating the space.

Left lateral could theoretically make sense as this should decrease filling pressure in the lumbar spine I would guess. Then again, I'm pretty solid with a sitting epidural and less so left lateral. I'd rather place 3 sitting epidurals over one left lateral haha.