CSF from Touhy after DPE - normal or wet tap?

[DocVapor]

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I honestly felt like I was quicker as a CA3 than I am now, because when on OB or pain then we did soo many. In PP I do maybe a handful a month because our hospital is low volume OB so I feel like I'm not as fast just due to the lack of repetition like I had then. I still am quick but just not guns blazing style lol

Same for me. Plus my new place has the Braun kits and where I trained had Arrow.

The arrow glass syringes with the metal leur lock tips are far, far superior to the Braun glass syringes. I've actually switched to the plastic syringes now as the compromise after trying that trick @SaltyDog described above.

 

[GassYous]

I honestly felt like I was quicker as a CA3 than I am now, because when on OB or pain then we did soo many. In PP I do maybe a handful a month because our hospital is low volume OB so I feel like I'm not as fast just due to the lack of repetition like I had then. I still am quick but just not guns blazing style lol

Don't need to be quick if you don't have a lot

Braun kit sucks. I've used arrow a few times. I get why people like glass.

 

[Monterosso]

In terms of continuous vs intermittent, I've found a combination of both very reliable: steady light pressure on the plunger with a slightly heavier "micro-pulse." I've found this technique great for both labor epidurals and also the fluoro suite.

Oddly, I use saline for labor epidurals but air for interventional pain (a main reason may be because saline is already in the labor epidural kits).

 

[deleted875186]

In terms of continuous vs intermittent, I've found a combination of both very reliable: steady light pressure on the plunger with a slightly heavier "micro-pulse." I've found this technique great for both labor epidurals and also the fluoro suite.

Oddly, I use saline for labor epidurals but air for interventional pain (a main reason may be because saline is already in the labor epidural kits).

I tend towards air in the pain clinic because were injecting particulate steroids, really don’t want any chance of intrathecal, easier to tell if there’s any CSF if you use air. Same with SCS, want to know if there’s any CSF.

 

[Katheudontas parateroumen]

So today I did a DPE with 25g pecan needle. Had that slow 1cc per couple second drop from the catheter and slight aspiration increase. Test dose did not create any motor blockade but I was still nervous and treated as intrathecal at that point and did a small pump solution bolus and low rate on the epidural. An hour later patient had no level and aspiration was now negative. Reno kissed her and set at the normal rate. No issues at all afterward.

 

[DrZzZz]

So today I did a DPE with 25g pecan needle. Had that slow 1cc per couple second drop from the catheter and slight aspiration increase. Test dose did not create any motor blockade but I was still nervous and treated as intrathecal at that point and did a small pump solution bolus and low rate on the epidural. An hour later patient had no level and aspiration was now negative. Reno kissed her and set at the normal rate. No issues at all afterward.

Your buddy Reno is gonna have a sexual assault charge on his hands.

 

[Southpaw]

So today I did a DPE with 25g pecan needle. Had that slow 1cc per couple second drop from the catheter and slight aspiration increase. Test dose did not create any motor blockade but I was still nervous and treated as intrathecal at that point and did a small pump solution bolus and low rate on the epidural. An hour later patient had no level and aspiration was now negative. Reno kissed her and set at the normal rate. No issues at all afterward.

Kissed her? Doesn't your buddy Reno realize that's what started the whole mess that led to everyone being there in the first place?!?!

 

[Katheudontas parateroumen]

LOL wtf autocorrect was that haha.

 

[deleted162650]

Wait, you guys don’t give ‘em a good luck kiss before leaving the room???

 

[GassYous]

Wait, you guys don’t give ‘em a good luck kiss before leaving the room???

Well when the average bmi and age are 40

 

[Southpaw]

Well when the average bmi and age are 40

my loins don't tingle unless bmi > 50

 

[deleted162650]

my loins don't tingle unless bmi > 50

That’s probably from the crushed pelvis.

 

[deleted875186]

So today I did a DPE with 25g pecan needle. Had that slow 1cc per couple second drop from the catheter and slight aspiration increase. Test dose did not create any motor blockade but I was still nervous and treated as intrathecal at that point and did a small pump solution bolus and low rate on the epidural. An hour later patient had no level and aspiration was now negative. Reno kissed her and set at the normal rate. No issues at all afterward.

Fascinating .... so I take it that some kind of CSF leak happens after the dural puncture, enough to fill the epidural space with enough volume to aspirate back on a catheter, which must be a goid amount because I e never been easily able to aspirate back a cath like that even with boluses. Really makes me never want to do a DPE, I certainly wouldn’t want one if I were the patient.

 

[patriot6]

Fascinating .... so I take it that some kind of CSF leak happens after the dural puncture, enough to fill the epidural space with enough volume to aspirate back on a catheter, which must be a goid amount because I e never been easily able to aspirate back a cath like that even with boluses. Really makes me never want to do a DPE, I certainly wouldn’t want one if I were the patient.

I almost always drop a 27G Whitacre on my tray. In my mind, a DPE is useful when there’s an equivocal loss of resistance, particularly in larger patients. The dural puncture assures me that I’m midline and that I’m not just threading this catheter into a dilated sub-q space of saline. I think there’s a place for DPEs, but I agree with other posters that it does seem silly to routinely poke a hole in the dura without any intention of putting drug in it.