Regional Questions

[climbingak]

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Just a general "what do you do in your practice" question. I know what the ASRA guidelines are but:

Does everyone generally wear a sterile gown when putting in a continuous peripheral nerve catheter? What about for an epidural placement?

Is everyone using sterile ultrasound probe covers for single shot block placements?

Thanks

 

[imfrankie]

Just a general "what do you do in your practice" question. I know what the ASRA guidelines are but:

Does everyone generally wear a sterile gown when putting in a continuous peripheral nerve catheter? What about for an epidural placement?

Is everyone using sterile ultrasound probe covers for single shot block placements?

Thanks

No, no and no.

For single shots I put a tagaderm over the probe. A single shot is like an IV. Plenty of experts use no cover, no lube, put the probe in position then wipe a little entry area with beta or chlora or alcohol then put the needle in.

 

[ssmallz]

Single shot - tegi over the probe cover, sterile gloves, +/- hat and mask depending on if I have them on or not, sterile gel

Catheter - sterile sheath over probe, full prep and drape, sterile glove, hat, and mask, no gown though. Sterile gel on skin, non sterile gel in sheath, sterile gel on outside.

Epidural placement - same way I do it on OB, hat, mask, sterile gloves, prep and drape from kit

 

[B-Bone]

single shot - tegi over the probe cover, sterile gloves, +/- hat and mask depending on if i have them on or not, sterile gel

catheter - sterile sheath over probe, full prep and drape, sterile glove, hat, and mask, no gown though. Sterile gel on skin, non sterile gel in sheath, sterile gel on outside.

Epidural placement - same way i do it on ob, hat, mask, sterile gloves, prep and drape from kit

+1

 

[RussianJoo]

for epidurals we wear sterile gloves, a mask and hat and we drape the back with a sterile plastic. for single shot blocks with US we use sterile probe covers, just like we do for central lines. Central lines we wear sterile gowns, sterile gloves, masks and hats and a full body drape, and sterile probe covers, for a-lines we just wear sterile gloves, mask and hat and drape the area.

 

[BLADEMDA]

Single shot - tegi over the probe cover, sterile gloves, +/- hat and mask depending on if I have them on or not, sterile gel

Catheter - sterile sheath over probe, full prep and drape, sterile glove, hat, and mask, no gown though. Sterile gel on skin, non sterile gel in sheath, sterile gel on outside.

Epidural placement - same way I do it on OB, hat, mask, sterile gloves, prep and drape from kit

Pretty much the same as above. While I am 100% compliant with wearing a mask for OB, Epidural or SAB I am less than 50% for single shot nerve blocks.

 

[climbingak]

Ok, thanks for the replies so far.
Just thinking I might be out of line for a second. I place about 7-8 CPNB per week and I just wear sterile gloves, hat, and mask. Use an epidural tray so prep it like an epidural (chloraprep and drape) and use sterile probe cover. I never wear a gown. Ive done about 250 of them over the past year. Today I had a young gal come in with pain at the insertion site and into the back of her knee after day #3 (I do these outpatient). Her husband (a paramedic) took the cath out last night but she still had pain today. It was a little red but no fluctuance, pus or pain in the popliteal fossa (continuous sciatic). So I aspirated under her insertion site and started her on Keflex for a presumed superficial infection (with consultation with the surgeon).

Anyway I go to my good friend google and see the ASRA guidelines telling me to wear a gown. Ive seen tons of places do these and nobody wears a gown that I could remember. I feel like those guidelines leave me flapping out there in the breeze if this infection were worse and somehow went to litigation. I was just making sure I wasn't crazy. I figured Ive never done it with OB epidurals and thats neuraxial. Plus I never feel in danger of the cath getting contaminated.

I do about 8-10 single shot blocks a day and don't use a sterile probe cover. I wonder if thats breaking a guideline too? My needle insertion site is at least a couple centimeters away from my US probe and its a one shot. Anyway just feeling more vulnerable knowing these guidelines are out there if I happened to have a complication.