Wet tap, COVID + patient

[fadedrebel]

Good Evening, need to pick your collective brains...

Patient s/p NSVD with a labor epidural. Develops a spinal headache. Would you do a blood patch if the patient is COVID positive (asymptomatic). If not, other options (cosyntropin? blood patch with saline?)

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[anbuitachi]

Good Evening, need to pick your collective brains...

Patient s/p NSVD with a labor epidural. Develops a spinal headache. Would you do a blood patch if the patient is COVID positive (asymptomatic). If not, other options (cosyntropin? blood patch with saline?)

if you were willing to put in a labor epidural, i dont see why you wouldnt be willing to do a blood patch. i dont think nurses are refusing blood draws, and clearly you arent refusing labor epidural for covid patients

 

[fadedrebel]

thanks, Yea, we still do epidurals and spinals on these patients. Just being cautious about injecting 15-20 mls of potentially infectious blood directly into the epidural space. No info that I can find regarding COVID 19 and blood patches... Still not sure if it safe to do. Patient opted for "conservative" treatment which buys a day or 2 before the decision is revisited. Any one else with an opinion?

 

[vector2]

thanks, Yea, we still do epidurals and spinals on these patients. Just being cautious about injecting 15-20 mls of potentially infectious blood directly into the epidural space. No info that I can find regarding COVID 19 and blood patches... Still not sure if it safe to do. Patient opted for "conservative" treatment which buys a day or 2 before the decision is revisited. Any one else with an opinion?

https://www.nejm.org/doi/full/10.1056/NEJMc2008597

PCR of the CSF was negative in this small series of COVID+ pts, so it’s not like HIV which already infects the CNS early in the disease. And even if it was, we don’t have enough data to say the reward of blood patch (no one is dying from a headache) outweighs the potential risks given how new the disease is. I wouldn’t do it.

 

[Ronin786]

https://www.nejm.org/doi/full/10.1056/NEJMc2008597

PCR of the CSF was negative in this small series of COVID+ pts, so it’s not like HIV which already infects the CNS early in the disease. And even if it was, we don’t have enough data to say the reward of blood patch (no one is dying from a headache) outweighs the potential risks given how new the disease is. I wouldn’t do it.

It's not a blood borne pathogen though. Obviously the safest thing would be to avoid it, but I don't see how there's any added harm. Also there's almost certainly already spread of blood into the dural space/CSF during insertion/wet tap.

 

[axeon123]

I thought/recalled reading in vitro the covid19 was shown to be able to infect endothelial cells, after getting through the lungs.

My place had a case like this recently, after some discussion with the patient about what her goals were for her PDPH, they did sphenopalatine ganglion block not with a needle but with a q-tip, heard patient had immediate relief and did pretty well.

 

[Beeftenderloin]

Good Evening, need to pick your collective brains...

Patient s/p NSVD with a labor epidural. Develops a spinal headache. Would you do a blood patch if the patient is COVID positive (asymptomatic). If not, other options (cosyntropin? blood patch with saline?)

Can always try this:

Addition of Neostigmine and Atropine to Conventional... : Anesthesia & Analgesia

4) for treating PDPH in addition to conservative management of 85 patients with hydration and analgesics. The primary outcome was a visual analog scale score of ≤3 at 6, 12, 24, 36, 48, and 72 hours after intervention. Secondary outcomes were the need for an epidural blood patch, neck stiffness...

journals.lww.com

 

[CubsDynasty]

Sphenopalatine? Don’t know of any case reports in COVID patients with NP viral infection?

 

[Planktonmd]

This virus crosses the blood brain barrier so there is no additional risk from injecting blood in the epidural space.

 

[deleted162650]

Just do the patch. We all know COVID is just a hoax propagated by the dems to get Trump out of office anyways.

 

[cde]

I have used cosyntropin twice and had great results. It's non invasive and cheap - less than $50 at our hospital. What do you have to lose? If it doesn't work then do the blood patch.

 

[fadedrebel]

I have used cosyntropin twice and had great results. It's non invasive and cheap - less than $50 at our hospital. What do you have to lose? If it doesn't work then do the blood patch.

I ended up giving cosyntropin as I have had success with that before. Seemed to help a bit when I checked up on her before my call ended. Signed out the patient to the on-coming doc. Will be interested to hear about the outcome if patient does end up wanting more definitive treatment.

 

[anbuitachi]

how much do you guys use?

I have used cosyntropin twice and had great results. It's non invasive and cheap - less than $50 at our hospital. What do you have to lose? If it doesn't work then do the blood patch.

I ended up giving cosyntropin as I have had success with that before. Seemed to help a bit when I checked up on her before my call ended. Signed out the patient to the on-coming doc. Will be interested to hear about the outcome if patient does end up wanting more definitive treatment.

 

[CubsDynasty]

how much do you guys use?

1.0 over 8 hrs, previous institution did .75

 

[anbuitachi]

1.0 over 8 hrs, previous institution did .75

you infuse 1 over 8 hours..?

 

[CubsDynasty]

1.0 mg in 1L over 8 hr, sorry thought it was obvious since previous poster asked about dose

 

[deleted875186]

I don’t think we have any evidence that there is a viremia stage in infection. Probably blood patch is ok, but I wouldn’t do anything invasive during an acute infection unless medically necessary. ACTH 1 mg, fioricet, wait several days, do the blood patch if patient wants it several days out and is still asymptomatic.