- Joined
- Jun 20, 2005
- Messages
- 8,022
- Reaction score
- 2,815
Are you calling me an “old timer”?You can go paramedian with a 25 without an introducer. We had one old timer staff in residency that would do all his spinals paramedian with a 25 Whit with no introducer and no skin local.
I routinely do paramedian without introducer. I actually nearly never use an introducer. Our kits changed the all metal one to a yellow plastic one and some partners were talking about how they didn’t like it. I never noticed the change happened.
The key to using a 25or 27g without an introducer is to drive the needle with your nondominant hand just beyond the skin. For example, I grab the needle with my right hand and apply gentle pressure from the back of the needle while also pinching the needle about 1cm from the skin and pushing it in from this point. My fingers contact the skin and I grab it again another cm back. The tissues act as your introducer by not allowing the needle to bow. I had an attending that loved to give you just one 27g whit to do your spinal at the VA. Then he would have you dose it with 25mg of isobaric marcaine.