Epidural Ligament Engagement Feel

[Status Sciaticus]

How do you know if you wet tap while using the saline method? You just keep aspirating if you suspect it?

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[IMGASMD]

How do you know if you wet tap while using the saline method? You just keep aspirating if you suspect it?

Oh….. you KNOW, when you take off your syringe…..

But just the other day, I actually saw a little swirl when I aspirated, but I was okay. Not sure what that was about.

If you intubate with a Mac blade you should use air...saline if you use a Miller...

Then I am bit of an anomaly then.

 

[Status Sciaticus]

Oh….. you KNOW, when you take off your syringe…..

But just the other day, I actually saw a little swirl when I aspirated, but I was okay. Not sure what that was about.



Then I am bit of an anomaly then.

Right, I've done saline before but I've had some obese patients where they either bear down or the saline from the syringe comes right back out of the tuohy. I guess I should just wait a while and see if it just keeps pouring out more than the 3 CCs I inject with

 

[Drwine]

One pointer I have to offer for using saline for LOR. If you are in the epidural space downward traction on the needle won't change the feel of the injection. Any other location that could give a false LOR will cause increased resistance with downward needle traction. I agree that air is more sensitive but I only teach the use of saline because to many people the LOR that should be determined with only 0.5 cc becomes an injection of 4-5 cc. I am aware of pneumocephalus and patchy blocks from overzealous injection of air.

 

[IMGASMD]

Right, I've done saline before but I've had some obese patients where they either bear down or the saline from the syringe comes right back out of the tuohy. I guess I should just wait a while and see if it just keeps pouring out more than the 3 CCs I inject with

All the wet taps I’ve had, CSF doesn’t flow out…. It gushes out.

I suppose while using a 16G touhy really make it not subtle….

 

[Arch Guillotti]

How do you know if you wet tap while using the saline method? You just keep aspirating if you suspect it?

csf gushes out almost always. Not always.

 

[Mman]

if you wet tap with the needle, the CSF comes shooting out. If the needle isn't through the dura but the catheter pokes through, your aspiration of clear fluid becomes unending. I mean maybe you injected 2 or 3 mls of saline for your LOR. When the aspiration syringe is at 5 ml of fluid and still coming back it is pretty obvious.

 

[Status Sciaticus]

All the wet taps I’ve had, CSF doesn’t flow out…. It gushes out.

I suppose while using a 16G touhy really make it not subtle….

I'm relatively new and haven't wet tapped someone yet thus I dont know the difference regarding the CSF flow, but that probably just means I haven't done enough epidurals.

 

[DocVapor]

I'm relatively new and haven't wet tapped someone yet thus I dont know the difference regarding the CSF flow, but that probably just means I haven't done enough epidurals.

You'll know it when you pull the syringe off and all of a sudden your shoes are soaking wet.

 

[nimbus]

All the wet taps I’ve had, CSF doesn’t flow out…. It gushes out.

I suppose while using a 16G touhy really make it not subtle….

And it’s nice and warm as it gushes out and hits your pants.

 

[pocafx]

I like when csf back fills the LOR syringe. I typically push all the csf back then remove touhy and try again

 

[IMGASMD]

And it’s nice and warm as it gushes out and hits your pants.

“Nice and warm” with a side dose of, oh **** me…..

 

[Sandman0300]

Ive been doing ob for a while and I have never used saline. My colleagues who do use saline are getting more wet taps.

No they’re not. You just think they are because you believe air is better.

 

[BobLoblaw78]

I think the important takeaway is to not set limits on getting better. I thought that I had epidurals down and wouldn't even try to engage the LF before putting on the LOR syringe. Once I had attending take over what I thought was a difficult epidural. He sunk the needle without LOR syringe to the LF. He then told me to put on the syringe and finish the procedure! I'd say almost half of patients you can reach the LF without the syringe. As soon as I have any doubt about location, then I add the syringe if I don't want to redirect.

 

[IMGASMD]

I think the important takeaway is to not set limits on getting better. I thought that I had epidurals down and wouldn't even try to engage the LF before putting on the LOR syringe. Once I had attending take over what I thought was a difficult epidural. He sunk the needle without LOR syringe to the LF. He then told me to put on the syringe and finish the procedure! I'd say almost half of patients you can reach the LF without the syringe. As soon as I have any doubt about location, then I add the syringe if I don't want to redirect.

Had an attending like that. Cocky as hell, does chronic pain. Would just drive the needle in, take out the stylet,

“we are right there. Just go slow…..”

 

[deleted875186]

Had an attending like that. Cocky as hell, does chronic pain. Would just drive the needle in, take out the stylet,

“we are right there. Just go slow…..”

Cocky or expert?

Dudes probably put in more epidurals than peripheral IVs in his career if he does pain.

 

[IMGASMD]

Cocky or expert?

Dudes probably put in more epidurals than peripheral IVs in his career if he does pain.

Lil’ of both….