epidural position tricks

[aredoubleyou]

What are your tricks for OB patients who cannot/ will not get in a good position? How about the movers? It makes a 5 minute procedure into a huge time investment.

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[dhb]

I say if you move you might be paralyzed if they move again then say next time i'll stop this elective procedure and you can have p.o meds. Never had to go to resolution number 2.

Best way to get in position is to cut the relaxed shoulders, head position BS: the women barely remembers her name and you're asking her to do 3 things at a time.
Put your finger where you're going to stick the Tuohy and tell them to push their lower back against your finger.

 

[Frank Rizzo]

What are your tricks for OB patients who cannot/ will not get in a good position? How about the movers? It makes a 5 minute procedure into a huge time investment.

Tell them I'll come back when they're ready to follow directions, then I leave the room. Usually gone for no more than five minutes until I'm called back in the room. Sort of a dick move, but it works. I did it yesterday for one patient. If the patients are verbally abusive to the staff or myself, I do the same thing.

 

[drmwvr]

What are your tricks for OB patients who cannot/ will not get in a good position? How about the movers? It makes a 5 minute procedure into a huge time investment.

I find that if Mum is on her side with the very edge of the matress along her spine, hips and shoulders at 90 degrees, the matress acts as a splint allowing her to stay reasonably still and in good position. As for what to tell her, I say don't worry in the least about moving and that she won't be paralyzed if she does. And I mean it. I just tell her that she's not to leave the room as I'm placing the epidural which usually gets a little giggle. It is amazing how still they become.

 

[CanGas]

Now I don't recommend this approach. As said to a moving, non-english speaking OB patient by a resident out of our program a few years now at 5:30 am after a brutal night on call. "YOU MOVE, YOU DIE!!!!" That's probably going to get you in trouble but haven't we all thought it at some time?

Majority of patients when you explain the procedure will be able to stay still. Those with severe contractions I tell them to let me know when one is coming and I will pause what I am doing and allow them to wiggle slightly side to side until the contraction is over then proceed. However, I don't think you are talking about those type of patients are you? You are talking about the hysterical, out of her mind, thrasher. These ones can be dangerous. I do 1 of 2 things. A) have the nurse give a dose of fentanyl IV to calm them down. B) More commonly will just slip in a quick spinal between contractions. 1cc Marcaine 0.25% + Fentanyl 25mcg via a 25g spinal needle. Yes I usually use a 27g but when time is of the essence a 25g is a little faster if you need more than 1 poke to find the space. Stops the pain immediately then you do a 2nd stick for the epidural. (Spinal is NOT put in with a CSE needle).

CanGas

 

[turnupthevapor]

i just say sacca la espalda............... and boom perfect position

still have no idea what that translates to but it works

 

[Dr Lyss]

i just say sacca la espalda............... and boom perfect position

still have no idea what that translates to but it works

translates to "take out your back" roughly

 

[Fastrach]

Last night on call, 6:30 am after being up all night with crash c-sections, nickel & dime epidural calls, etc., get a page for an epidural in a large mentally "slow" honey who according to her H&P had "anger issues". Yeah, perfect epidural candidate, I told the OB resident.... She seemed like a straight-shooter though, talking to her before we got started, so we figured, what the hell, let's give it a whirl. Put the needle in and she's just got NO ligament back there, just a bunch of mush. Diggin' around just to find something to seat the needle in, she starts to get chippy, as are we, telling her to just hold still for crap's sake. Tough time getting her to not lean/wiggle/jiggle throughout. Starts gettin up in my grill after I hit os at 7cm, so staff takes over and with a little brutane hubs it at 9cm and mercifully gets a loss. CSE in, epidural in, and all is well with the world again.

My one thought as we struggled was, please god, don't let her reach back behind her, grab the tuohy, and jam it thru my eye socket. That would have been one helluva a wet tap....

 

[Noyac]

Now I don't recommend this approach. As said to a moving, non-english speaking OB patient by a resident out of our program a few years now at 5:30 am after a brutal night on call. "YOU MOVE, YOU DIE!!!!" That's probably going to get you in trouble but haven't we all thought it at some time?

Majority of patients when you explain the procedure will be able to stay still. Those with severe contractions I tell them to let me know when one is coming and I will pause what I am doing and allow them to wiggle slightly side to side until the contraction is over then proceed. However, I don't think you are talking about those type of patients are you? You are talking about the hysterical, out of her mind, thrasher. These ones can be dangerous. I do 1 of 2 things. A) have the nurse give a dose of fentanyl IV to calm them down. B) More commonly will just slip in a quick spinal between contractions. 1cc Marcaine 0.25% + Fentanyl 25mcg via a 25g spinal needle. Yes I usually use a 27g but when time is of the essence a 25g is a little faster if you need more than 1 poke to find the space. Stops the pain immediately then you do a 2nd stick for the epidural. (Spinal is NOT put in with a CSE needle).

CanGas

My technique exactly. Just place a spinal and they are comfy enough to hold still. If they still won't then tell OB they 1.5 hrs to deliver that baby.