Too many wet-taps

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memberncc1701

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I need someone to talk me off a ledge

I'm an anesthesia resident on my first OB rotation and in about a month I've had 5 (yes five) wet-taps. At this point I'm basically terrified at the thought of ever doing another epidural and the thought of changing specialties has crossed my mind.

The first one was one of my very first epidurals and the head of OB anesthesia was actually looking over my shoulder. Glass syringe, incremental technique 1mm at a time, middle fingers bracing against the back while advancing with needle between my thumb and index finger on both sides. Good crisp loss, the attending actually said "perfect job"... and then I took off the syringe and got CSF in my face. Attending said that there was nothing different that they would have done.

Second one was in the middle of the night, again attending looking over my shoulder, patient jumped as I was advancing using the same technique as above....got loss and clear fluid. Again, attending said nothing to do differently.

Third, again, late at night with attending supervising, obese patient, same technique, got some blood in the syringe and needed to re-approach several times. Each time I cleared the needle with the stylette and washed the inside of the syringe with saline. I was advancing and the attending actually said "you can be more aggressive" but given my past at this point I continued to move slowly. I was worried the needle was clogged so I cleared it with a stylette again and boom...CSF everywhere. Attending said there was nothing to do differently.

Fourth, in the OR doing a CSE. An attending had suggested I try the plastic LOR syringe for the first time because I had only been using glass until this point. Advancing slowely using technique above with attending watching...syringe begins to fill with CSF. Attending says there is nothing to do differently.

Fifth, in the OR doing a CSE....I had avoided using plastic syringes again until this point but attending says that I should give it another try. Same exact scenario as above...advancing slowly with attending watching, no loss at all, syringe begins to fill with CSF. Attending says there was nothing to do differently.

So at this point I'm at a loss. Clearly I suck at epidurals, but every time the attending has sort of given me a talk about how "these things happen" and it's "all part of learning." I ask for feedback every time, what could I do differently, but they always say that my technique looked perfect to them. Unfortunately there isn't much learning to do if there is no obvious change to be made.

FML
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memberncc1701 said:
I need someone to talk me off a ledge

I'm an anesthesia resident on my first OB rotation and in about a month I've had 5 (yes five) wet-taps. At this point I'm basically terrified at the thought of ever doing another epidural and the thought of changing specialties has crossed my mind.

The first one was one of my very first epidurals and the head of OB anesthesia was actually looking over my shoulder. Glass syringe, incremental technique 1mm at a time, middle fingers bracing against the back while advancing with needle between my thumb and index finger on both sides. Good crisp loss, the attending actually said "perfect job"... and then I took off the syringe and got CSF in my face. Attending said that there was nothing different that they would have done.

Second one was in the middle of the night, again attending looking over my shoulder, patient jumped as I was advancing using the same technique as above....got loss and clear fluid. Again, attending said nothing to do differently.

Third, again, late at night with attending supervising, obese patient, same technique, got some blood in the syringe and needed to re-approach several times. Each time I cleared the needle with the stylette and washed the inside of the syringe with saline. I was advancing and the attending actually said "you can be more aggressive" but given my past at this point I continued to move slowly. I was worried the needle was clogged so I cleared it with a stylette again and boom...CSF everywhere. Attending said there was nothing to do differently.

Fourth, in the OR doing a CSE. An attending had suggested I try the plastic LOR syringe for the first time because I had only been using glass until this point. Advancing slowely using technique above with attending watching...syringe begins to fill with CSF. Attending says there is nothing to do differently.

Fifth, in the OR doing a CSE....I had avoided using plastic syringes again until this point but attending says that I should give it another try. Same exact scenario as above...advancing slowly with attending watching, no loss at all, syringe begins to fill with CSF. Attending says there was nothing to do differently.

So at this point I'm at a loss. Clearly I suck at epidurals, but every time the attending has sort of given me a talk about how "these things happen" and it's "all part of learning." I ask for feedback every time, what could I do differently, but they always say that my technique looked perfect to them. Unfortunately there isn't much learning to do if there is no obvious change to be made.

FML
Click to expand...

Choke up the needle. Go slow. Nothing done differently. It’s all about tactile feedback you get. Don’t change your technique.... use one “way” of doing it until you’re consistent. Saline, air, glass, plastic, whatever.
It happens, anyone says they never get one is a liar.
 
IMGASMD said:
Choke up the needle. Go slow. Nothing done differently. It’s all about tactile feedback you get. Don’t change your technique.... use one “way” of doing it until you’re consistent. Saline, air, glass, plastic, whatever.
It happens, anyone says they never get one is a liar.
Click to expand...

"It" does not happen that many times. You need to have an attending do one and both of you scrubbed in and have them really go through each step and feel what they are feeling. 5 times in a short time span is unacceptable. Your attendings need to do a better job of teaching you and not just saying they wouldn't do anything diffferently. That being said you'll eventually get it and itll be second nature.
 
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As for the emotional element of it, rest assured, there ARE residents that have that many. I know of a resident that had about that many in one NIGHT!

that said, get better. I’ll let others chime in on the mechanics.
 
Use saline with a little air bubble and the loss is more noticible to me. I use more air when people have more “mushy” interspinous ligament and I know LOR won’t be very apparent.

The ligament flavum is thickest at the bottom of the interspace. Start at what you perceive to be the bottom of the space (top of the more inferior spinous process) and gradually adjust upwards if you encounter bone. Keep asking the patient if they feel you on the left or right—99% of the time they are right and will help

Good luck
 
My friend I truly believe simulation would help you. Our program invested in a epidural simulator. Check with your PD and see if you have one. Relax it will be ok!
 
I got several wet taps in a row while using intermittent technique. I switched to continuous technique and feel it's worked well for me, faster and less wet taps. When doing intermittent, even if you are advancing 1mm at a time, you are advancing blindly without feedback. With continuous, your hand is always on the plunger and the instant you advance beyond ligamentum flavum, you will have LOR. This has helped me and maybe can help you.

Also agree with other posters above: totally normal to get many wet taps, do not feel too bad as you are learning, stick with one thing and don't try too much at once.

Also, personally I much preferred learning from senior residents than attendings. Ask a senior resident you think is good to help you.
 
If you never had a successful one and these were five in a row.... then.... take some time off, and regroup.
Epidural is probably one of the hardest procedures that we do. Even with someone scrub in, it’s hard to teach. Let’s say the needle is engaged, you can be in the interspinous..... then you push a little too hard, oops.

at best you can have a good attending (if your pain guys do take ob calls, even better...) have them get to right before the flavum and you can push it in? Even with that, there are some tough tough flavum... I’ve had hand cramps at the end of day when it’s a busy day. I will also say that different needles will feel different. I had to retrain myself when I first joined my group.

Take your time, if your hospital isn’t crazy busy and you have time and your attednings let you. If your attendings aren’t blaming you for wet taps, even better!

PS. I’ve had two groups of anesthesiologists who expressed feelings on wet taps.
1. “You suck, you will never be a good ob anesthesiologist. Wet taps aren’t acceptable, why are you giving a raging headache to new moms. And I don’t want to blood patch your mistakes.”
2. “Oh, I’ve been doing this a long time, it’s no big deal. We patch them and move on, at worst they get a headache for a few days. You’re doing fine, I’ve seen someone who put 15 holes in someone’s back and still couldn’t get it in.”
Guess whose voice I keep in my head when I do my epidurals alone in the middle of the night?

Good luck!
 
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Man, I feel OP here. I had several wet taps in my first several epidurals and it absolutely shook my confidence.

Your staff isn’t helping, “nothing I wouldn’t do” is not adequate when this keeps happening (actually, they are hurting you). Only thing I can figure from what you’ve said is you must be going too far into the epidural space - you say you’re going in 1 mm at a time but it must be that you are blowing through the ligament straight into the dura. This is common for newbies (and why I refused to have anyone under a PGY-4 do my wife’s epidural!)! When you’re engaged, slow and steady does it. Have an attending or senior resident scrub in with you and help.

I totally feel you, but don’t give up on yourself that easily! You’ll get it, just need a little extra help!
 
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nolagas said:
Use saline. Push harder so when you are in you’ll know it.
Click to expand...

Saline, an air bubble, and a lightweight plastic LOR syringe helped me when I was a resident. Switched to the continuous technique when I was an attending. Sometimes I still switch back to the intermittent technique when the needle is almost hubbed.

Also put the stylet back in, if you need to, or flush the needle if you think you might have a plug. If you have doubts or feel like you may be too deep, pull the whole thing out and start at a different location before you get the wet tap.
 
Do you remember if the epidurals where you had wet taps were particularly lengthy in time or involved a lot of re positioning? It is not uncommon for material to lodge into the tip of the needle if you are proceeding excruciatingly slowly or hitting bone a lot and redirecting. You may benefit from intermittent re-styletting of the needle. If these did not involve a lot of repositioning or time, were you saying anything to the patient that led them to believe they could sit up a little straighter or relax their positioning that may have caused the needle to shift?

Ultimately 5 wet taps in a month isn't something that should have you rethinking your career choice and judging your skill, but it is enough that you should examine if there is something you are doing consciously or unconsciously that is causing you to advance the needle just a little too far. It is possible you are expecting a more dramatic "give" or loss of resistance than tends to occur so you are missing it when it happens and continuing forwards.

You will get better with time, and since you cared enough to post this on here you likely possess the right combination of shame and mettle to improve without much intervention from others.
 
+1 to using continuous technique (instead of intermittent). Also, keep an idea in your head where to expect LOR while doing the procedure. On average, it’s around 5cm. So once you get to 4cm, start being more careful. Until 3cm you don’t have to worry much and can move as fast as you want.
 
agammaglobulin said:
+1 to using continuous technique (instead of intermittent). Also, keep an idea in your head where to expect LOR while doing the procedure. On average, it’s around 5cm. So once you get to 4cm, start being more careful. Until 3cm you don’t have to worry much and can move as fast as you want.
Click to expand...

Depends on patient population. 5 cm sounds shallow for our patients..
 
Another vote for continuous technique. I am right handed. Once I have engaged ligament... I use my left hand to grip the Tuohy between my thumb and index finger while resting the back of my left hand on the patients back. Left hand is my "brake"... With my right thumb, and only my right thumb, i advance the plunger of a saline filled glass syringe. Steady continuous pressure. Nothing other than my thumb on the plunger applies forward movement of the needle. If you aren't midline, and engaged in the interspinous ligament, the needle doesn't advance. Once you exit ligamentum flavum, the needle doesn't advance. Agree that you are getting insufficient feedback. Someone, that knows what they are doing, needs to have gloves on and confirm what you are feeling.

JC
 
Lots of technical tips people can offer but the only thing I'll say is learn to recognize the crunchiness of passing through the flavum and then you can expect the soon to follow LOR. Once you've done enough you usually know when the loss is without even checking the LOR because you feel the little give after exiting the flavum as you advance.
 
+1 on the above. Your left hand gives you nearly as much information as your right thumb on the plunger.
 
Mman said:
Lots of technical tips people can offer but the only thing I'll say is learn to recognize the crunchiness of passing through the flavum and then you can expect the soon to follow LOR. Once you've done enough you usually know when the loss is without even checking the LOR because you feel the little give after exiting the flavum as you advance.
Click to expand...

Yep. sometimes the supraspinous ligament is also crunchy, but this will be shallow and needle will still be floppy vs imbedded.
 
You get pretty hefty epidural exposure during that month on OB so you're bound to see the complications happen.

One more wet tap now is one less wet tap when you are out in the real world unsupervised.
 
I'd also add that if you try to appreciate the emotional experience of your attendings. Likely none of them feel "disappointment" towards you. Try to consider what it would be like if you didn't feel disappointment towards yourself. Put your experience into context: You are TRAINING.
 
Sounds like the thing in common with all of your approaches is intermittent technique. I am still a resident, but I only use intermittent technique for very tough ligaments when I have a winged catheter, as I feel two hands give me more control when I'm needing to use more force. For others, I go with continuous technique. It's a bit scarier at first since you have to do it all at once and you may feel tempted to stop and start doing it intermittently, so just make sure you mentally prepare all the steps in your head and do a mental motor rehearsal of what you're going to do first. Don't get too hung up on it. You're already doing everything right as far as keeping track of each mistake and analyzing them. Just keep working on it, and you'll be fine. As somebody else said, ask if you have an epidural simulation tool to practice on.
 
As a current resident, I can tell you that I don’t think switching to continuous technique will solve your problem. I always use intermittent, once I feel engaged in ligament I go very slowly, a couple mm at a time. Excellent advice above, have someone glove with you and feel the syringe. Sounds like you have LOR but aren’t recognizing it. It should be very easy to inject with the big gauge toughy. I’ve only had one wet tap, happened in a guy with a previous fusion, went a level above, didn’t feel that any ligament, advanced and go CSF. My advice is, never advance the needle if in doubt at all. Come out, redirect, try and confirm we’re you are and that you get a good loss.
 
Pain guy here. I use intermittent technique, LOR to air. This will come with practice. You're advancing much further than you think. If you are getting fluffy loss, compress the skin with thumb and index finger at the needle tip and you'll get less subQ dispersion of air and a much more reassuring bounce.

You need to get some confidence and then figure out your own technique and system. Like most technical tasks in Anesthesia, one day soon things will just "click" for you and you won't wet tap for the rest of the year.

I think continuous advancement with saline for you right now will ---> beaucoup wet taps and further degradation of confidence.
 
61November said:
I think continuous advancement with saline for you right now will ---> beaucoup wet taps and further degradation of confidence.
Click to expand...

Maybe you missed the part where the intermittent technique wasn’t workin’ out so hot for him right now. LOR to air for a labor epidural is a good way to create “hot spots” and a less than stellar epidural. The bubble of air in the saline is key.

Also, plastic LOR syringes are for pain guys. Use the glass, OP.
 
SaltyDog said:
Maybe you missed the part where the intermittent technique wasn’t workin’ out so hot for him right now. LOR to air for a labor epidural is a good way to create “hot spots” and a less than stellar epidural. The bubble of air in the saline is key.

Also, plastic LOR syringes are for pain guys. Use the glass, OP.
Click to expand...

Really? I've used both and I prefer plastic.
 
Continuous technique - saline in the plastic syringe. Lots of pressure when you're in flavum, push away the dura as you pop through flavum. Can't cause a defect in something that isn't there.
 
Ok dont take offense...
You can do this!!!!

I was the worst resident they had ever seen... now i'll harpoon a whale with the 6 inch needle left lateral and out of the room in 15 mins..

You can do it, but...

You re at the stage where you might not know what you know or dont know. You're telling us 1 mm but how do you know that? A true 1 mm push is unlikely to cause a tap, it might have been 3 mm or more?

My advice is find a friendly, patient, skilled staff and have a heart to heart. you need them to scrub in with you and 'share' a back or 2 or 3. let them do a bit then you do a bit...

I learned lor with air intermittent so when im stuck i go back to that...

You need to critique everything from positioning, lighting seating, layout of your tray, glove size, nurse assisting you, spiel you provide the patient...
Every single thing you do, they do feeds into your initial success rate. Its a confidence game....

Or you could just be **** out of luck. Some people dont have flavums that meet in the midline... so your LOR is thru to csf... its only about 1% but possible
 
Newtwo said:
You re at the stage where you might not know what you know or dont know. You're telling us 1 mm but how do you know that? A true 1 mm push is unlikely to cause a tap, it might have been 3 mm or more?
Click to expand...

Nobody advances 1 mm at a time. The markings on the needle are 1 cm or 10 mm. Nobody checks LOR 10 separate times for each mark on the needle when they are doing intermittent. Maybe 2-3 mm is about the best anyone will do.
 
Mman said:
Nobody advances 1 mm at a time. The markings on the needle are 1 cm or 10 mm. Nobody checks LOR 10 separate times for each mark on the needle when they are doing intermittent. Maybe 2-3 mm is about the best anyone will do.
Click to expand...
Agreed, best I can do when I know I’m in ligament and going very slowly is check 3-4 times per cm of toughy. I have heard the epidural space is usually 0.5 cm or so, so you should be ok so long as your not advancing too fast.
 
memberncc1701 said:
I need someone to talk me off a ledge

I'm an anesthesia resident on my first OB rotation and in about a month I've had 5 (yes five) wet-taps. At this point I'm basically terrified at the thought of ever doing another epidural and the thought of changing specialties has crossed my mind.

The first one was one of my very first epidurals and the head of OB anesthesia was actually looking over my shoulder. Glass syringe, incremental technique 1mm at a time, middle fingers bracing against the back while advancing with needle between my thumb and index finger on both sides. Good crisp loss, the attending actually said "perfect job"... and then I took off the syringe and got CSF in my face. Attending said that there was nothing different that they would have done.

Second one was in the middle of the night, again attending looking over my shoulder, patient jumped as I was advancing using the same technique as above....got loss and clear fluid. Again, attending said nothing to do differently.

Third, again, late at night with attending supervising, obese patient, same technique, got some blood in the syringe and needed to re-approach several times. Each time I cleared the needle with the stylette and washed the inside of the syringe with saline. I was advancing and the attending actually said "you can be more aggressive" but given my past at this point I continued to move slowly. I was worried the needle was clogged so I cleared it with a stylette again and boom...CSF everywhere. Attending said there was nothing to do differently.

Fourth, in the OR doing a CSE. An attending had suggested I try the plastic LOR syringe for the first time because I had only been using glass until this point. Advancing slowely using technique above with attending watching...syringe begins to fill with CSF. Attending says there is nothing to do differently.

Fifth, in the OR doing a CSE....I had avoided using plastic syringes again until this point but attending says that I should give it another try. Same exact scenario as above...advancing slowly with attending watching, no loss at all, syringe begins to fill with CSF. Attending says there was nothing to do differently.

So at this point I'm at a loss. Clearly I suck at epidurals, but every time the attending has sort of given me a talk about how "these things happen" and it's "all part of learning." I ask for feedback every time, what could I do differently, but they always say that my technique looked perfect to them. Unfortunately there isn't much learning to do if there is no obvious change to be made.

FML
Click to expand...

Welcome to training. There’s nothing more frustrating than learning how to do epidurals in OB, especially since this is one of those skills that really just takes experience and numbers to get used to the “feel”. I had my share of wet taps when starting out.

I personally think the continuous technique is a bit more advanced and may be something you can start once you have have several hundred under your belt, but I think doing that to start risks more wet taps up front and more frustration (not arguing against the technique since I know it works well for many)

I still use intermittent with glass and saline. Get the needle in at least 3cm in a skinny and 4-5 in a bigger before checking to speed things up.

I use small movements and check often. Left hand on needle right checking the LOR. Once you get the motion down you’ll do it fast enough that it almost seems continuous.

Position is everything. Make sure they are in the appropriate position.

The LOR with saline is almost always extremely obvious. There should be no doubt you are in
 
Newtwo said:
Or you could just be **** out of luck. Some people dont have flavums that meet in the midline... so your LOR is thru to csf... its only about 1% but possible
Click to expand...

Thank you for this. The other day I wet tapped twice. I swear I did not feel “anything”. I just aborted afterwards. Maybe could have left a spinal catheter, but where I was trained that was a no no. So just pulled the needle out. What makes this story even sadder, was the fact she was the nicest patient that I had in a long time.
I suspected it was some weird anatomy, it’s nice to hear someone say it out loud.
 
IMGASMD said:
Thank you for this. The other day I wet tapped twice. I swear I did not feel “anything”. I just aborted afterwards. Maybe could have left a spinal catheter, but where I was trained that was a no no. So just pulled the needle out. What makes this story even sadder, was the fact she was the nicest patient that I had in a long time.
I suspected it was some weird anatomy, it’s nice to hear someone say it out loud.
Click to expand...

My worst epidurals have been on the best patients. Only wet tapped the very kind understanding respectful patients while the rude, demanding patient with an antagonistic doula and overbearing mother of course gets perfect LOR, easy placement and no issues with the epidural.
 
Arch Guillotti said:
Nonsense.:prof:
Click to expand...

Planktonmd said:
:thinking::thinking:
Click to expand...

Sounds like we have some LOR to air fans in the house 😀. I readily admit that there are many studies showing equivalent outcomes between air and saline. But here are a few which support my claim (channeling my inner @BLADEMDA):

Epidural spread of iohexol following the use of air or saline in the 'loss of resistance' test. - PubMed - NCBI

Quality of analgesia when air versus saline is used for identification of the epidural space in the parturient. - PubMed - NCBI

Comparative study of the effects of air or saline to identify the extradural space. - PubMed - NCBI

My hunch is that when using air, volume injected matters. If you are slick and don’t inject any more than a cc or so then I’m sure you won’t see any issues. But, if you’re not so slick or have a mushy loss and end up putting 4-5cc of air epidurally, then I think the possibility of creating some air-locked pockets is very real.

I like these discussions because there are so many ways to skin the epidural cat that it always leads to some good debate. Bottom line is that if there was really one BEST way, we would all being doing that way. Lots of approaches work with plenty of room for personal style. All that being said, my way is still the best way 😉.
 
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memberncc1701 said:
I'm an anesthesia resident on my first OB rotation and in about a month I've had 5 (yes five) wet-taps. At this point I'm basically terrified at the thought of ever doing another epidural and the thought of changing specialties has crossed my mind.....

So at this point I'm at a loss. Clearly I suck at epidurals, but every time the attending has sort of given me a talk about how "these things happen" and it's "all part of learning." I ask for feedback every time, what could I do differently, but they always say that my technique looked perfect to them. Unfortunately there isn't much learning to do if there is no obvious change to be made.
Click to expand...

5 on OB is a bit extreme, but if you did 100 in a month, that's still just 5%. Obviously it's not where you want to be, but that's not unreasonable for a new learner.

Clearly your attendings though suck at teaching/giving feedback. I suspect they really weren't watching your actions if they had no feedback and are more concerned about your psychology than your technique. Find the person that rips people to shreds, and ask them to roast your technique on a few.

I agree with a stimulator. That's a great way to learn/practice.

The biggest thing I find with new learners is the amount of pressure for LOR. It's hard to be consistent with intermittent. It's not really a full loss of resistance in some patients, but more a change in the amount of resistance. Too much pressure, too little pressure, or varying amounts of pressure can give you different answers to the position.
 
Hey everyone, thanks for all the feedback and LOTS of good tips. Last night I had several quite challenging epidurals and everything went smoothly. Obviously problem not solved but I'm feeling a bit better about everything with all the support and ideas for ways to change my practice. Thanks everyone!
 
memberncc1701 said:
Hey everyone, thanks for all the feedback and LOTS of good tips. Last night I had several quite challenging epidurals and everything went smoothly. Obviously problem not solved but I'm feeling a bit better about everything with all the support and ideas for ways to change my practice. Thanks everyone!
Click to expand...

So what did you change (if anything) that helped? That info might help someone else who’s struggling right now.
 
Count me in the group that thinks OP should stick with intermittent technique (very slowly) with a saline/air bubble glass syringe. When I have a tricky epidural I always fall back on intermittent, and so do the pain guys.

Who’s doing all of OP’s blood patches?

Speaking of wet taps, does anyone do sphenopalatine ganglion block for PDPH? If so, when? First line conservative treatment in the first 24hrs with the fioricet and fluids before offering EBP?
 
Unmistakable entry into the epidural space is unmistakable. If I’m not sure I’ll usually pull it out and start over because the extra time upfront saves me a headache later.
 
memberncc1701 said:
I need someone to talk me off a ledge

I'm an anesthesia resident on my first OB rotation and in about a month I've had 5 (yes five) wet-taps. At this point I'm basically terrified at the thought of ever doing another epidural and the thought of changing specialties has crossed my mind.

The first one was one of my very first epidurals and the head of OB anesthesia was actually looking over my shoulder. Glass syringe, incremental technique 1mm at a time, middle fingers bracing against the back while advancing with needle between my thumb and index finger on both sides. Good crisp loss, the attending actually said "perfect job"... and then I took off the syringe and got CSF in my face. Attending said that there was nothing different that they would have done.

Second one was in the middle of the night, again attending looking over my shoulder, patient jumped as I was advancing using the same technique as above....got loss and clear fluid. Again, attending said nothing to do differently.

Third, again, late at night with attending supervising, obese patient, same technique, got some blood in the syringe and needed to re-approach several times. Each time I cleared the needle with the stylette and washed the inside of the syringe with saline. I was advancing and the attending actually said "you can be more aggressive" but given my past at this point I continued to move slowly. I was worried the needle was clogged so I cleared it with a stylette again and boom...CSF everywhere. Attending said there was nothing to do differently.

Fourth, in the OR doing a CSE. An attending had suggested I try the plastic LOR syringe for the first time because I had only been using glass until this point. Advancing slowely using technique above with attending watching...syringe begins to fill with CSF. Attending says there is nothing to do differently.

Fifth, in the OR doing a CSE....I had avoided using plastic syringes again until this point but attending says that I should give it another try. Same exact scenario as above...advancing slowly with attending watching, no loss at all, syringe begins to fill with CSF. Attending says there was nothing to do differently.

So at this point I'm at a loss. Clearly I suck at epidurals, but every time the attending has sort of given me a talk about how "these things happen" and it's "all part of learning." I ask for feedback every time, what could I do differently, but they always say that my technique looked perfect to them. Unfortunately there isn't much learning to do if there is no obvious change to be made.

FML
Click to expand...
As somebody who considered himself the "Wet Tap King" during CA2 year, all I have to say is 5 wet taps are rookie numbers.

Keep wet tapping away until you get it. And keep your head high...., because your patients can not.
 
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