Nerve catheter with epidural kit

[turnupthevapor]

We are low on stimulator kits for catheters. Do you guys think it would be okay to do a catheter with an epidural tray. the catheters seem similar. I find I don't need to stimulate anymore anyway. the tray is 16 bucks in stead of 100 for bbrauns kit

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[thegasman]

i have used this before with success while in residency. If you are good with ultrasound and you don't need to stimulate anyway, you can get away with just using the epidural kit.

 

[pgg]

😕
Are you talking about not using any stimulation, using ultrasound instead, and using an epidural needle and catheter for the nerve block? Or are you referring to using an epidural catheter with a stimulating needle, in place of a stimulating catheter?

Either way, I don't see why you couldn't.

The only real pitfall I see are that the peripheral nerve catheters I've used tend to be a lot stiffer than epidural catheters. It might be technically more difficult to get the soft epidural catheter to thread into the nerve sheath, but I don't know.

 

[periopdoc]

Virginia Mason uses the Braun 17g Tuohy Needle and flexible wire wrapped epidural catheter for the majority of their ultrasound guided nerve blocks. I spent a couple of months there. Threading the catheter is no problem, and it doesn't tend to migrate where you don't want it to be. It is also really easy to see with U/S.

You can see the catheter extending through the needle and past the tip in this image.


You could also place it through a stimulating needle without difficulty if you have large enough stim needles. Most of the ones we have at UW are too small to thread the catheter so try it out before you have a needle in the patient.

Of course you cant stimulate this catheter, but it sounds like you don't care about that.

- pod

 

[sevoflurane]

We are low on stimulator kits for catheters. Do you guys think it would be okay to do a catheter with an epidural tray. the catheters seem similar. I find I don't need to stimulate anymore anyway. the tray is 16 bucks in stead of 100 for bbrauns kit

Used them all the time for paravertebral as well as for lumbar plexus using LOR. Stiff epidural catheters work pretty well.

 

[G.O.B. III]

Am a resident at VM. Periop doc is correct, except that we use the arrow kits with the 17 Ga tuohy needle with a 19 Ga wire reinforced catheter as opposed to the Braun. We do an in-plane ultrasound technique, with the nerve in short axis... so we do not overfeed the catheter along the plane of the nerve in long axis, which I have seen done at Seattle Children's with stimulating catheters... so it depends on your technique which catheter is superior. I will say this, the flexible catheters do tend to stay anchored in the soft tissue better than stiff catheters.