I only place an intrathecal catheter if the reason I got the wet tap was because I was having such a difficult time getting the damn thing in in the first place. I thread it 3-4cm past the tip and run it at 3cc of 1/16 bupi solution with fentanyl and take away the PCEA button.
Otherwise, I take out the needle and start again, mostly for nursing reasons. In this case, I start the epidural infusion at the normal rate but give the patient and nurse instructions for what to watch for, and I check back frequently during the first hour or two. Sometimes the dural puncture can lead to a high level, but honestly this happens pretty rarely. Any evidence of a high level, I drop the rate way down until the level starts drops, then slowly increase the rate until the level is where it should be, but take away the PCEA and give careful signout about boluses.
C sections are more complicated obviously. In an emergency I'd just dose it up, maybe 1/2 what I'd normally do, then check. But I've only been in that situation once. Another time, I signed out a catheter like this to a really reckless colleague and that patient got a totally unnecessary GA section after being given an initial bolus that was insane given the known issues with the catheter.
