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deleted162650
If you check out my idea earlier in the thread for a direct A-line to Tuohy connection, I think that would be JW friendly.
Doing blood patches alone
- Thread starter castafari
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If you check out my idea earlier in the thread for a direct A-line to Tuohy connection, I think that would be JW friendly.
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People are putting in arterial lines for EBP's?!!
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My solo EBP technique is, open all epidural tray and IV stuff onto epidural tray, sit pt up, glove, prep and drape back. Go around to pt's front and sterilely put in a smaller (20g or 22g) PIV in a fat AC vein, and cap it with one of those one-way Luer caps. Next, go get LOR. Then, come back and draw your 20-25ml blood and inject.
Pitfalls I encountered in the process included:
1) trying to do a phlebotomy instead of PIV, or trying to put a sterile PIV in a more-comfortable-for-the-patient, location. You need that blood and you need it NOW once you get LOR.
2) doing it lateral. In my experience, pts can sit up for the 5-10 minutes that this takes.
3) not using the biggest/most chlorapreps you can find
4) trying to do it fully solo - you should at least have an RN around who can open sterile things for you or put up / let down your tourniquet, moral support for pt, etc.
Pitfalls I encountered in the process included:
1) trying to do a phlebotomy instead of PIV, or trying to put a sterile PIV in a more-comfortable-for-the-patient, location. You need that blood and you need it NOW once you get LOR.
2) doing it lateral. In my experience, pts can sit up for the 5-10 minutes that this takes.
3) not using the biggest/most chlorapreps you can find
4) trying to do it fully solo - you should at least have an RN around who can open sterile things for you or put up / let down your tourniquet, moral support for pt, etc.
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deleted162650
There's no problem drawing blood first (sterilely) before starting the epidural portion. The blood will not clot in the 5 minutes it takes you to get LOR. Even if it thickens up slightly - that's what you want right? If the blood clots before you can access the epidural space, well then you really need to work on your technique.
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Why are you all doing blood patches alone? Is it really that difficult to find a nurse to help out?
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Of course.
4% topical lidocaine soaked in two MRSA swabs for a minute.
Separately introduce them into the nares until you meet resistance. They have holes in the back if you take that red cap off, so I inject another cc or so of 4% lido through the back. Let it sit there for 5-10 minutes and take them out. Really easy to do. I'm going to start experimenting with bupivicaine to see if it lasts any longer.
This is a good video right here:
Anecdotally it works for regular migraines as well.
Of course.
4% topical lidocaine soaked in two MRSA swabs for a minute.
Separately introduce them into the nares until you meet resistance. They have holes in the back if you take that red cap off, so I inject another cc or so of 4% lido through the back. Let it sit there for 5-10 minutes and take them out. Really easy to do. I'm going to start experimenting with bupivicaine to see if it lasts any longer.
This is a good video right here:
Anecdotally it works for regular migraines as well.
Let us know how bupi works as I’ve never tried it. But my impression is that 4% lido works the best. With these types of blocks, it is more about ‘resetting’ whatever process is going on. That’s why people can get weeks worth of migraine or facial pain relief despite the fact that the local wears off within a very short period of time.
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deleted697535
Some blood patches dont work first time either
@SaltyDog - theres no needle, just a swab soaked in lidocaine.
And as ive said already a small trial said lido worked just as well as a blood patch for up to a week. No need to use bupiv
It was originally developed for migraine wasnt it?
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Yah that's a good idea! I don't understand how the Witnesses don't think that's cheating - but whatever floats their boats.
You'd potentially need a long connecting sterile field depending on how OCD you are about sterility, and would have the flush the lines with saline first, but definitely a cool idea.
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No, they are just doing a quick and easy blood draw. Does it really matter what vessel it comes from?
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there's a few wanna be superstar nurses that try to pull this at my gig. i just go about my biz-nass. if they try to be snarky and stop until i stop i just shrug. "I get paid by the hour my friend. we can do this all day"
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NEVER do anything solo......always have a witness. i barely even interview patients without a nurse present let alone lay hands on the patient.
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During interview season, some residents shared a story with me last year of them doing exactly this in San Antonio for a JW.
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I am all for doing stuff on your own w/o help. Leaving a tuohy needle in a patients back while you get 20ccs of blood is not one of them. Patients can go vagal, pass out and fall backwards with a needle aimed right at their spinal cord. Not criticizing, but just pointing out why I never do an EBP solo. Risk/Benefit is not in favor of doing this.
