Whee do you do blood patches

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ethilo

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Yesterday I had to do a blood patch and heard from the nurse a prior attending came up to do one up on the step down ward after the mom delivered. I insisted she come to PACU or back to the L&D unit so she could get monitoring and be near all the safety equipment rather than me taking my equipment to her, even if she's just monitored during the procedure and for 30 mins after then sent back to her room. It would have been more convenient to do it on the ward as the charge nurse needed to deploy a nurse for supervision of the patient in the recovery room. Is this too conservative of a move?

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Yesterday I had to do a blood patch and heard from the nurse a prior attending came up to do one up on the step down ward after the mom delivered. I insisted she come to PACU or back to the L&D unit so she could get monitoring and be near all the safety equipment rather than me taking my equipment to her, even if she's just monitored during the procedure and for 30 mins after then sent back to her room. It would have been more convenient to do it on the ward as the charge nurse needed to deploy a nurse for supervision of the patient in the recovery room. Is this too conservative of a move?

I just take my handful equipment with me and do it in her post partum room. I don’t know that any of my partners insist on bringing the patient back to L&D or place them in a monitored bed.
 
I’m not sure why monitors are needed for an EBP at all.

Assuming you’re not sedating the patient or otherwise performing an anesthetic, the ASA standards don’t apply.

Maybe I’m crazy and out in the wilderness here.
 
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Another question-do make your patients NPO prior to doing the patch? I do, but some colleagues think I'm wrong. My rationale is if I unknowingly inject 20 mL of blood intrathecally, I now have a new mother seizing with a full stomach...
 
No, they don't need to be NPO.

I do it in PACU/our block area because I have help around and it's easier in the work flow of my day to squeeze it in.
 
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I like the pulse ox for when they vagal, but otherwise I'm not sure it's necessary.

The NPO thing just makes it more annoying for you/them with their volume status/ability to get blood/risk for VV.

I would do it wherever you have the extra hands for it, but don't need to make a monitoring/safety pitch as if anything bad happens, you're looking for a crash cart and extra hands either way.
 
I’m not sure why monitors are needed for an EBP at all.

Assuming you’re not sedating the patient or otherwise performing an anesthetic, the ASA standards don’t apply.

Maybe I’m crazy and out in the wilderness here.

I don't think it has anything to do with sedation. If you're sticking a needle in a lady's back and she happens to vagal/pass out/ANYTHING happens, you'll be happy you have at least a few monitors on her.

And though I feel dirty saying this since I hate altering my practice based on medicolegal concerns, you really would have no leg to stand on if anything were to go wrong and you didn't have a single monitor on her.
 
I don't think it has anything to do with sedation. If you're sticking a needle in a lady's back and she happens to vagal/pass out/ANYTHING happens, you'll be happy you have at least a few monitors on her.

And though I feel dirty saying this since I hate altering my practice based on medicolegal concerns, you really would have no leg to stand on if anything were to go wrong and you didn't have a single monitor on her.

Well ... I'm in a contrary mood so I'll argue that we don't put monitors on people to start IVs. The outpatient lab doesn't do it to draw blood. The ER doesn't do it to sew up lacerations. The immunization clinic doesn't do it to give people flu shots. People vagal down and pass out from seeing those needles all the time.
 
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I usually do them in the lumbar area.

tghf.gif
 
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I usually do them in the ER, which is where they usually are when I get informed that someone came back because dudes are still doing LPs with huge cutting needles.
 
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Neurologic complications related to epidural blood patch include those occurring at the time of the procedure and symptoms predominately happening after epidural blood patch. This latter group includes paresthesias, neck ache, facial nerve palsy, and lumbovertebral syndrome. [5,6 ] Neck and backache, seizure, severe headache secondary to pneumocephalus, and transient bradycardia have been reported during and immediately after the procedure. [5,7–9 ].


Epidural Blood Patch Can Cause Acute Neurologic Deterioration | Anesthesiology | ASA Publications
 
Well ... I'm in a contrary mood so I'll argue that we don't put monitors on people to start IVs. The outpatient lab doesn't do it to draw blood. The ER doesn't do it to sew up lacerations. The immunization clinic doesn't do it to give people flu shots. People vagal down and pass out from seeing those needles all the time.

Agree. At the same time I would argue that sticking a 17g needle a couple cm away from the spinal cord is more invasive than those items listed, and more can potentially go wrong with a blood patch than it can with these procedures listed.

Also, above all else is takes literally a minute to do and gives me something to scribble down on my record to make it look not-so-naked.
 
nt J Obstet Anesth. 1996 Jan;5(1):43-6.
Unexpected postpartum seizures associated with post-dural puncture headache treated with caffeine.
Paech M1.
Author information

Abstract
This report describes a case of isolated postpartum seizures, in an apparently healthy woman who had suffered an accidental dural puncture during epidural analgesia for labour, and was on caffeine for relief of post-dural puncture headache. Investigation failed to determine the aetiology of the seizures. The possible contribution of dural puncture and caffeine toxicity are discussed.
 
Another question-do make your patients NPO prior to doing the patch? I do, but some colleagues think I'm wrong. My rationale is if I unknowingly inject 20 mL of blood intrathecally, I now have a new mother seizing with a full stomach...
What the F*ck?
I have never heard of this.
The poor lady is suffering from a PDPH and you want to make her NPO?
I’m confused.

I’m sorry but this is one of the craziest things I have heard in a long while.
 
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I have placed thousands of epidurals. It is my experience that pts having procedures for issues that are causing some acute distress, labor or PDPH, are extremely unlikely to vagal or experience syncope. I have had a couple syncopal episodes during epidural placement for pain pts. The only two that I remember were cervical epidurals. The key is positioning. If they are positioned well,then they don’t drop on you. They just slowly start to slump.
 
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