CSE
Started by dabears505
I just assume this means I'm not midline so i usually pull the needle back and redirect, anticipating LOR at a similar depth.
Try another level.
Advertisement - Members don't see this ad
Arch Guillotti
Senior Member
Staff member
Administrator
Volunteer Staff
Lifetime Donor
20+ Year Member
Once in a great while. What I do depends on how hard the epidural is to begin with and what is it going to be used for.
D
deleted162650
One of 2 things is going on:
1) You actually got a great false loss. You can go a head and thread, but you'll be back in 30 mins to do it all over again.
2) As mentioned above, you are off midline. Either you came in at a decent angle, but were far off lateral, or you came in an angle going off one side or the other. Either way, when you advance, the spinal needle it's staying in the epidural space off lateral to the thecal sack. An epidural Cath threaded here will still work, but may be one-sided or just not optimally effective (or it may be fine). My approach at this point depends - just like Arch said.
I ended up threading and luckily didn't get called back again. It just didn't feel like a false loss. I felt good ligament and it was one of those where the loss is almost confirmation of getting through.
I thought this study was pretty insightful: Failed dural puncture during needle-through-needle combined spinal–epidural anesthesia: a case series. TLDR, it's probably a combination of excess paramedian needle deviation and the spinal needle exiting slightly cephalad to the Tuohy needle's trajectory. All their patients had a normal or relatively normal BMI, too.
if you already have great loss, might as well thread it and see if it works. If it doesnt, youll do it again, which is what you would do otherwise as others have suggested. So it can help, but cant really hurt.
Take the spinal needle out, turn the touy 90 degrees and try the spinal needle again. You might be in epidural space but a touch off midline and miss the dura. Turning the touy will angle it left or right to get the sprotte back to midline. It happened to me twice and had csf came out after i turned the touy.
D
deleted875186
I’ve occasionally not had good CSF flow and have rotated the spinal needle and got good flow, maybe the whiratcre hole was up against a nerve root.
CSE for CS, do a different level.
CSE for labor, just thread the catheter.
CSE for CS, do a different level.
CSE for labor, just thread the catheter.
Advertisement - Members don't see this ad
Don’t do a CSE.
D
deleted875186
If you do a intrathecal injection in the pain clinic under fluoro you appreciate in bigger people how easy it is to go off midline, can still access the epidural space but not be able to pierce through dura.
D
deleted697535
Push the touhy in til you get csf, then pull back til you don't. Thread catheter. You're welcome
D
deleted162650
Don’t forget to bolus a cc or 2 intrathecally. Otherwise it’s just a DPE, which is stupid.
Personally I like to thread a catheter into the intrathecal space, pull the needle back a cm, and thread a second catheter alongside the first one into the epidural space. I call this technique “the continuous CSE”... Just make sure that when you label the 2 catheters, you use the same color and write really small. L&D nurses love it
D
deleted162650
It’s cleaner if you hook them both up to a 3-way stopcock.
Real og trick is to throw a swan in there so you can dilate the space for the catheter and also pick how high you want your level
How big of a needle are you using that you can threading two catheters? Do you infuse both?
It's a double barrel needle obviously.
D
deleted162650
You can squeak ‘em both through a 14g - just gotta spit on ‘em first.
Advertisement - Members don't see this ad
So THIS is the DPe technique I've been hearing about?
