SCS - securing the trial lead to the skin

[wscott]

Hi,

For those of you with good experience doing SCS trials, what method do you think works the best to secure the trial leads to the skin. Do you use a stitch? How do you stitch it? Do you use Steristrips? Tagaderm? Tape?

Opinions are all over the map. One thing is for sure, it sucks to do all that work and have the lead move during the trial.

Thanks for your input.

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[SleepIsGood]

Hi,

For those of you with good experience doing SCS trials, what method do you think works the best to secure the trial leads to the skin. Do you use a stitch? How do you stitch it? Do you use Steristrips? Tagaderm? Tape?

Opinions are all over the map. One thing is for sure, it sucks to do all that work and have the lead move during the trial.

Thanks for your input.

anyone who tells you it wont move during the trial....

I can tell you at our institution we do a mixture of all the above..also try abdominal binder.

 

[facets]

The one time I just taped them, steri-strips, op-site, the patient pulled them out, the one time I tried tunneling, I pulled it down. Since then I have tried a chest tube tie and none have moved

 

[SleepIsGood]

The one time I just taped them, steri-strips, op-site, the patient pulled them out, the one time I tried tunneling, I pulled it down. Since then I have tried a chest tube tie and none have moved

I think what you are referring to is the "figure of 8 tie". I know of a neurosurgeon that routinely does that. He states it works for him...

 

[lobelsteve]

2 or 3 single stitches per lead.

2 front 1 back on the skin before the Tuohy is placed, drop in a Tuohy, run in the lead, push/pull, then tie 2 front/1 back to sandwich the lead between the knots.

I started using Dermabond on top of this to help prevent oozing/bleeding. Cuts back on phone calls.

 

[axm397]

St. Jude found me a nice sticky back thing - has an indentation in the middle for the lead and two flaps to secure them - and I have been fine with that. I forgot what it is called.

 

[Pain_doc]

I used to suture. Last 20 or 30 I've used benzoin or mastisol with steri-strips (loop the excess lead). Cover exit site with gauze and medi-pore tape over it all. I've had one lead move after 3 days, but otherwise no problems.

 

[ParaVert]

drain stitch (figure of eight). 2-0 silk on a small needle (RV1) just caudal to the insertion site, square knot down on skin. Wrap the suture around the lead twice (figure of eight), square knot. Repeat. Mastisol a 2"X2" area caudal and lateral to insertion site, create a relief loop. Steri strip over the relief loop. 4X4 over the lead insertion site. Large Tegaderm over the whole thing secured with Medipore tape. NEVER had one pull out. Migration subcutaneously in fat people is a different story.

ps: for implanters - just tried the new Cinch-Lock anchor from ANS. Totally awesome.

 

[Aether2000]

http://www.merit.com/products/productdetail.aspx?id=1726

 

[axm397]

http://www.merit.com/products/productdetail.aspx?id=1726

yes - that is what i use. it's really nice. i used to throw some stitches in but that used to irritate the patients' skin - especially after not showering for a few days and with the tegaderm on top making things moist

 

[Jcm800]

drain stitch (figure of eight). 2-0 silk on a small needle (RV1) just caudal to the insertion site, square knot down on skin. Wrap the suture around the lead twice (figure of eight), square knot. Repeat. Mastisol a 2"X2" area caudal and lateral to insertion site, create a relief loop. Steri strip over the relief loop. 4X4 over the lead insertion site. Large Tegaderm over the whole thing secured with Medipore tape. NEVER had one pull out. Migration subcutaneously in fat people is a different story.

ps: for implanters - just tried the new Cinch-Lock anchor from ANS. Totally awesome.

used it a couple of days ago, i like it.

i do the suture, steristrips thing. they dont typically move...

 

[SleepIsGood]

drain stitch (figure of eight). 2-0 silk on a small needle (RV1) just caudal to the insertion site, square knot down on skin. Wrap the suture around the lead twice (figure of eight), square knot. Repeat. Mastisol a 2"X2" area caudal and lateral to insertion site, create a relief loop. Steri strip over the relief loop. 4X4 over the lead insertion site. Large Tegaderm over the whole thing secured with Medipore tape. NEVER had one pull out. Migration subcutaneously in fat people is a different story.

ps: for implanters - just tried the new Cinch-Lock anchor from ANS. Totally awesome.

At one of the meetins someone stated hey actually fillet the anchor and add fibrin glue then put the leads through that. The sutures it all in like normal. Anyone try that?

I've seen issues from the 'cinch' anchor....

 

[stim4u]

just implanted the new ANS pentad paddle with a spinal surgeon recently, and getting excellent back and leg coverage. Cost about $200 more than the traditional ANS paddle leads, but overall coverage appears much better....have not been able to use the new ANS anchor yet but am looking forward to it the next go-around.

 

[drusso]

yes - that is what i use. it's really nice. i used to throw some stitches in but that used to irritate the patients' skin - especially after not showering for a few days and with the tegaderm on top making things moist

I use the above. It's fast. I'm slow at sewing...

 

[Mister Mxyzptlk]

I make a loop of wire and hold it in place with Steri-strips. Then I place some more Steri-strips longitudinally along the axis of the wire as itheads toward the flank. Then I cover it all up with Medipore/Hypafix type of tape. I have not had a single one move using this technique.

I have, however, had a patient come back with the gray cable severed and the inner wires spliced back together with scotch tape. How did that happen? "I fell getting out of bed."

 

[lobelsteve]

We had a patient in our area (not mine), decide to end his trial early. He cut the wires off at the skin. The wires went in, the surgeon went in to get them out. Stupid rabbit, trix are for kids.

 

[hyperalgesia]

"I fell getting out of bed."

Jesus, what is with the falling patients? Every freaking day, for no apparent reason, our patients just spontaneously fall!

 

[Mister Mxyzptlk]

Jesus, what is with the falling patients? Every freaking day, for no apparent reason, our patients just spontaneously fall!

Probably all the drugs we give them.

 

[pars]

swift lock with 3 sutures. mastisol/steri-strip cut in half. strain relief loop. massive tegaderm. connector with its own strain relief loop. 2nd massive tegaderm over the whole thing.

 

[Jcm800]

i think i might try not suturing the next time. It never occurred to me as viable. I just assumed they would come out. Ill do the mastisol, steri strip, loop, then big old tegaderm/dressing on it...would be interesting to see if it comes out. Ill pick someone i dont like hahah

 

[bpainless]

mastisol then steristrips the way Mxyz explained then Tegaderm and then large Tegaderm with gauze over it.did not have problems so far

 

[foxtrot]

Does anyone let their patients shower during the trial period? I would think if you used a telfa and the medipore tape, a short shower should be okay. Obviously no soaking in a tube. But I commonly do my trials for 5 days and it hard for folks not to shower that long. Just curious what other do?

 

[lobelsteve]

Does anyone let their patients shower during the trial period? I would think if you used a telfa and the medipore tape, a short shower should be okay. Obviously no soaking in a tube. But I commonly do my trials for 5 days and it hard for folks not to shower that long. Just curious what other do?

No shower, no bath. Wash your face and parts with a moist cloth, but stay away from the dressing.

Portal of entry into the spine=osteomyelitis, discitis, meningitis.

Go to a course.

 

[hyperalgesia]

How long are your trials? I've been doing 5-7 days but I'm seriously thinking about decreasing to 3.

 

[lobelsteve]

7 day trial. Occl 5 day, As short as 3 day for successful trial.
as long as 14 day for PNS for occipital.

 

[drf]

How are you guys doing peripheral nerve/field stim trials? How do you secure the lead to keep it from moving during the trail? Same as epidural lead?