Strange Wet Tap

[bluewater]

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It has been almost 2 years since I last wet tapped a pt. Today, I had a 90yo female for a hip revision. Plan was to place an epidural. Plain vanilla approach, but there was no loss of resistance in the epidural space, then bam- I get fluid back, except it was strange in appearance and viscosity. This stuff was a yellowish/ light greenish tinted fluid and the consistency was like a thin syrup and very sticky. I don't know exactly what this stuff was, but I repositioned at another space and placed a catheter.

Anyone ever see this? or have any ideas?

Thanks

 

[Planktonmd]

It has been almost 2 years since I last wet tapped a pt. Today, I had a 90yo female for a hip revision. Plan was to place an epidural. Plain vanilla approach, but there was no loss of resistance in the epidural space, then bam- I get fluid back, except it was strange in appearance and viscosity. This stuff was a yellowish/ light greenish tinted fluid and the consistency was like a thin syrup and very sticky. I don't know exactly what this stuff was, but I repositioned at another space and placed a catheter.

Anyone ever see this? or have any ideas?

Thanks

Congratulations you just biopsied the intestine from a posterior approach.
👍
Let me guess: Your lady was really thin wasn't she??

 

[urge]

I wonder if he used the same shtty needle.

 

[Planktonmd]

I wonder if he used the same shtty needle.

😱

 

[bluewater]

Not skinny, she was a fatty. I was using the 9cm touhy. Only in about 5 cm. Try again.

 

[Fastrach]

Dude, seriously, either she a) had a rip-roaring meningitis, b) you got lost in some sort of abscess, or as been suggested c) your needle was FOS.... i sincerely hope you got a new needle before repositioning...

 

[Bertelman]

I've heard of something similar- sticky, yellowish fluid. The guy I heard it from suspected it was synovial fluid.


...but I may just be smoking crack.


Out of curiosity, why didn't you just save a little fluid and check it out under a scope?

 

[OB1🤙]

I've heard of something similar- sticky, yellowish fluid. The guy I heard it from suspected it was synovial fluid.

Synovial cyst maybe?

Assuming this fluid passed the sniff test and wasn't feculent, it makes sense.

 

[UTSouthwestern]

I've heard of something similar- sticky, yellowish fluid. The guy I heard it from suspected it was synovial fluid.

Bingo.

 

[maceo]

send it to the lab for analysis

 

[coprolalia]

I think you actually stuck the needle into another dimension. When you drew back on the syringe, you got ectoplasm. Call Ghostbusters.

-copro

 

[mille125]

It could have been a seroma. Synovial fluid is also a possibility.

 

[aphistis]

I think you actually stuck the needle into another dimension. When you drew back on the syringe, you got ectoplasm. Call Ghostbusters.

-copro

Copro FTW.

 

[bluewater]

OK here is the rest of the story- while sending the fluid to path for culture or viewing it under the microscope would have been ideal- it was not done. I did however test it for glucose and it was negative.

The report I got from the attending that was taking over the case was that the repeat placement never lead to a level after dosing with 15 mL of 2% lido.

He then repeated the epidural at a third level and had the same "sht" happen to him at the same depth but 3 levels lower than the initial placement.

(a different needle was used each time)

Pt went to sleep with no epidural.
Post op no complications (aside from the exorcism that was performed when the patient was on the ortho floor.)

 

[huktonfonix]

OK here is the rest of the story- while sending the fluid to path for culture or viewing it under the microscope would have been ideal- it was not done. I did however test it for glucose and it was negative.

The report I got from the attending that was taking over the case was that the repeat placement never lead to a level after dosing with 15 mL of 2% lido.

He then repeated the epidural at a third level and had the same "sht" happen to him at the same depth but 3 levels lower than the initial placement.

(a different needle was used each time)

Pt went to sleep with no epidural.
Post op no complications (aside from the exorcism that was performed when the patient was on the ortho floor.)

what level are you placing your epidurals for hips that your attending could place one three levels lower? Seems like youre starting a bit high...although thats not the reason for that fluid. No idea what that was if it happened repeatedly to different practitioners. Cyst or abscess or something.