How do you tape your epidural catheters?

[rc977]

I know it maybe difficult to describe your taping technique, but I am curious what some of you guys do. I am a CA-1 so relatively new at this, but I've already replaced a few epidurals that when I looked at the patient's back to see where the catheter was, it was almost dislodged.

We use the Braun/Perifix kits. I was taught to use the yellow foam pad, place a tegaderm over it (10x11 cm), use 3-4 pieces of 2 inch tape horizontally, and then one long tape vertically oriented to either shoulder. I've seen a few other tape jobs but haven't seen one that has convinced me to use a different technique.

Only reason I ask is that sometimes when I pull catheters out that I placed, the tape isn't on as tight (various "bubbles") as I'd like it to be and if the patient wiggles the catheter from the yellow foam, it appears the catheter has moved some.

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[jetproppilot]

I know it maybe difficult to describe your taping technique, but I am curious what some of you guys do. I am a CA-1 so relatively new at this, but I've already replaced a few epidurals that when I looked at the patient's back to see where the catheter was, it was almost dislodged.

We use the Braun/Perifix kits. I was taught to use the yellow foam pad, place a tegaderm over it (10x11 cm), use 3-4 pieces of 2 inch tape horizontally, and then one long tape vertically oriented to either shoulder. I've seen a few other tape jobs but haven't seen one that has convinced me to use a different technique.

Only reason I ask is that sometimes when I pull catheters out that I placed, the tape isn't on as tight (various "bubbles") as I'd like it to be and if the patient wiggles the catheter from the yellow foam, it appears the catheter has moved some.

I'm convinced that it doesnt matter how you tape it...as long as its a pretty good job.

The key to minimizing catheter displacement is to tell the lady how important it is for her not to drag her back on the bed when moving around in bed, and to have RNs who reinforce this.

 

[zippy2u]

How it gets played: Stay with Perifix with luer lock glass syringe and multi port cath-- best out there. Cath placed 4 cms into epidural space. Use spray tinture of benzoin at epidural site and up one side of back to shoulder(same side that pump will be at head of bed). Blot and dry with 4 by 4. Place clear 4 by 6 tegaderm over looped epidural cath. Throw away yellow thing. Place four 6" pieces of 2 inch silk tape over tegaderm in a superior to inferior fashion. Cover the remaining cath to shoulder with the 2 inch silk tape(one long piece). Regards, ---Zip

 

[zippy2u]

The critical thing is to throw that yellow foam pad away--- its monkey wrenchin' ya and phuckin' everything up. ----Zip

 

[mmag]

My hospital uses these things called Lock-it.
http://www.smiths-medical.com/plugins/news/2006/may/lockit-plus-catheter-securement.html

There is some research for this product.
http://www.ncbi.nlm.nih.gov/pubmed/11531673

Generally the residents use the Lock-it, paint mastisol all around it and up the back, put on the Tegaderm over the Lock-it, and silk tape the 4 edges of the Tegaderm as well as the path of the catheter up the back. Probably overkill but sure beats having to replace the epidural.

 

[jetproppilot]

How it gets played: Stay with Perifix with luer lock glass syringe and multi port cath-- best out there. Cath placed 4 cms into epidural space. Use spray tinture of benzoin at epidural site and up one side of back to shoulder(same side that pump will be at head of bed). Blot and dry with 4 by 4. Place clear 4 by 6 tegaderm over looped epidural cath. Throw away yellow thing. Place four 6" pieces of 2 inch silk tape over tegaderm in a superior to inferior fashion. Cover the remaining cath to shoulder with the 2 inch silk tape(one long piece). Regards, ---Zip

ZIPSTERS, YOU EVER BEEN WAXED, DUDE?

You know, like your hottie CRNA on her puta?

That s h it hurts.

S.O. bought a wax pot and went to town on me recently.

I've never seen her laugh so hard....I was whimpering like an infant with a diaper full of poo poo......

S.O. : "READY, HONEY?"

Jet: "YEAH, GO AHEAD."

S.O. pulls off waxed paper on Jet as deftly as she pops in a Trocar....

PHWAAAAAAAAAAAACK

Jet: "AAAAHHHHHHHHHHHHHHHH!!! OH MY #$%^ING GOD!!!! AHHHHH!!!!! MY SKIN IS GONE!!! MY SKIN!!!!"

S.O. erupts with laughter as I run into the adjoing room...assassin dog gives a scooby head tilt, then follows me into room to see whats wrong with whimpering dude.


That benzoin is like givin' the momma a wax job when the floor RN pulls it off.

I'm not convinced that helps catheter displacement.

So I save the momma-wax job for her visit to the sweat shop after she leaves the hospital.

 

[zippy2u]

Nah slick, never had the pleasure of gettin' a wax job--- no metrosexual shenanigans for me... Regards, ---Zip

 

[rsgillmd]

rc977, I do what you do. However, I don't use the yellow foam. I also do what Jet said -- I tell them that if they have to change position, to lift their back and move, as opposed to sliding.

I've been lucky -- two displaced catheters out of the hundreds of epidurals I've done, both on very sweaty people. Haven't really gotten bubbles either -- don't know why you are getting those.

 

[rc977]

I find it interesting that none of the responders seem to use the yellow foam. The one big disadvantage as well with it is if you want to see how far the catheter is taped, you pretty much have to take all the tape and foam off. Our OB department chair taught me to use the yellow foam so maybe that is why I have been sticking with it but wouldn't mind learning other successful ways. Not sure if any of mine have been replaced due to the catheter coming out a few cm's.

 

[militarymd]

No form.

mastisol spray...tegaderm...then silk tape...

 

[Frank Rizzo]

benzoin, 4 in tegaderm over insertion site, two loops in epidural cath as it goes up the back, covered by a long tegaderm(4x10"?), then tape the boarder or tegaderms with whatever papertape is available. No foam, so steri's. Seems to work well.

 

[Noyac]

W0w you guys sure are confident that the catheter won't move. Not me. I ain't coming back to replace it. Therefore, I get a 16g angio, slide the catheter off the angio needle. Insert the needle right next to the epidural insertion site and tunnel it laterally from the insertion site about 3 cm. Next I slide the angio cath back down the needle in the opposite direction and remove the needle. I then thread the epid cath thru the angio and pull the angio out. This effectively secures the cath subQ about 3 cm. Then I use some 1/4 in steri strips to wrap around the cath and secure it to the skin after wiping skin with mastisol. I spray benzoin up and down the back. Then I place a large 6X8 tegaderm over the site and tape it down along the sides. I now take some 4in micropore tape and run it along the back securing the cath over the shoulder on the same side as the IV.

Next I tell the pt "DON'T MOVE UNTIL THE BABY IS OUT"

 

[coprolalia]

I then thread the epid cath thru the angio and pull the angio out.

You tunnel all your epidural catheters? What kinda skin wheal of local are we talking about here? Otherwise, ouch! Would like to see that hematoma around the insertion site a day after you pull the catheter...

-copro

(P.S. Maybe I haven't done enough yet, but I've yet to have one in for less than 24 hours that's "slipped" out. And, certainly not heard of this ever occurring at the rate that would compel me to routinely tunnel them.)

 

[Noyac]

You tunnel all your epidural catheters? What kinda skin wheal of local are we talking about here? Otherwise, ouch! Would like to see that hematoma around the insertion site a day after you pull the catheter...

-copro

(P.S. Maybe I haven't done enough yet, but I've yet to have one in for less than 24 hours that's "slipped" out. And, certainly not heard of this ever occurring at the rate that would compel me to routinely tunnel them.)

It was a joke Copro.

I do exactly what Zippy described.

I do tunnel the thoracic caths and any post-op caths that will remain for more than 1 day. All you need to do is inject lido subQ along the path that you will tunnel the angio. I frequently use the Lido c epi for this. No hematomas ever. You are subQ.

 

[jetproppilot]

It was a joke Copro.

I do exactly what Zippy described.

I do tunnel the thoracic caths and any post-op caths that will remain for more than 1 day. All you need to do is inject lido subQ along the path that you will tunnel the angio. I frequently use the Lido c epi for this. No hematomas ever. You are subQ.

WHEW!!

Thank God you were joking, Dude.....I was like.....WTF?

I was gonna suggest maybe you should add some epoxy....or mix up some concrete and lay her in it.

 

[Noyac]

WHEW!!

Thank God you were joking, Dude.....I was like.....WTF?

I was gonna suggest maybe you should add some epoxy....or mix up some concrete and lay her in it.

Gotcha

 

[Trisomy13]

I was gonna suggest maybe you should add some epoxy....or mix up some concrete and lay her in it.

one word....


staples.



"ok ma'am the catheter is in place and just a second here and ok and.. *thwach thwack thwack thwack thwack* ... there we go all secure thank you and good night congratulations and it was a pleasure to be involved in this miracle called birth."

back to sleep.

and it gives the med students something to do when it's time to remove them.

 

[coprolalia]

It was a joke Copro.

I tunnel catheters that are going to stay in for a couple (or three) days, especially the ones in the groin and the butt (i.e. fem/sciatic). We get about 1:5 hematomas at the tunnel site.

-copro

 

[Noyac]

I tunnel catheters that are going to stay in for a couple (or three) days, especially the ones in the groin and the butt (i.e. fem/sciatic). We get about 1:5 hematomas at the tunnel site.

-copro

Yeah, hematoma's are more common at the peripheral sites. I never see them in the epidural sites though. I am really superficial also. YOu can almost see the catheter traveling under the skin.

 

[coprolalia]

Yeah, hematoma's are more common at the peripheral sites. I never see them in the epidural sites though. I am really superficial also. YOu can almost see the catheter traveling under the skin.

Cool. I'll try to be more superficial next time I tunnel.

-copro

 

[MacBook]

This is all I have to contribute.Thats what is used here. No idea how the actual site on the back might be taped down.

 

[coprolalia]

This is all I have to contribute.Thats what is used here. No idea how the actual site on the back might be taped down.

I feel like I need to take a cold shower after looking at that pic. (Joking.)

That filter looks very excessive and obtrusive, by the way. Obviously another example of a medical device designed by someone who has no real idea about the actual mechanics of what we do.

-copro