confirmfing peripheral catheter placement

[GA8314]

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During training, we did not dilate any space before threading our catheters for PNB's. We then used 1.5 ml or so of air to confirm under US, the location of the catheter.

We are developing a program and want to standardize our methods. I'm not sure this is the best way but it worked quite well for us at a very busy acute pain service.

Curious what others are doing to confirm catheter placement for peripheral blocks...

 

[GaseousClay]

We like to thread the catheters using ultrasound guidance and make sure we don't over thread past the nerve. Also like to see a lot of loops in the muscle as we pull out the needle. Then confirm with air like you do. Haven't had any problems with this method. Can not overstate the importance of securing the catheter to the skin. A big shame to do all that work and have it come out because your tegaderm/tape job sucks.

 

[fakin' the funk]

How we did them in training:
Do block w/ 20-35ml of 2% lido or 1.5% mepi
Thread catheter into massive pocket of local, only 2-3cm past Tuohy tip but then lots of loops into muscle/SC tissue on the way out, verify tip position w/ 1ml air
Mastisol, Tegaderm at site then Tegaderm "trail" prn away from surgical field, Arrow Stat-lock at site with the extra loops of catheter going under the Stat-Lock

 

[RussianJoo]

We would place the catheters with both ultrasound and nerve stim with most attendings. Once the catheter was in we would inject the local through the catheter and watched for the muscle twitch to go away. With some attendings we just used ultrasound, and once the catheter was placed would inject the local through the catheter just visualize the placement of the catheter. For most of the attending if not all of them we would tunnel the catheters using tuohy and the metal stylet that's in the tuohy. We never looped the catheters in the muscle and never used air to check for placement.