2. Spinal & CSE Placement

Question 1

what is the 2mL vial of .75% marcaine used for?

Answer 1

injected into CSF for spinal

Question 2

what is the most common spinal dose of marcaine for OB?

Answer 2

1.4-1.6mL

10.5-12mg

Question 3

what syringe is used for intrathecal local anesthetic?

Answer 3

5mL syringe

Question 4

what gauge needle is on the spinal syringe?

Answer 4

18ga or 22ga

used to draw up the macaine in the spinal syringe

Question 5

what gauge needle is used to inject the lidocaine for the skin wheel?

Answer 5

25ga needle

Question 6

what is the spinal needle usually? gauge and type

Answer 6

25ga

whitacre needle

Question 7

when should the introducer needle be used

Answer 7

when the spinal needle is smaller than 22ga

Question 8

what gauge is the introducer needle

Answer 8

18ga

Question 9

what is the benefit to using the introducer needle

Answer 9

less likely that your spinal needle is going to bend

Question 10

which way should the bevel on the spinal needle be oriented?

Answer 10

sideways to reduce the risk of PDPH

Question 11

steps to spinal placement 16

Answer 11

1. Open the kit
2. Open the narcotic vial if using narcotics
3. Put on sterile gloves
4. Prep the patient
5. Apply the sterile drape
6. Draw up everything while waiting for the betadine to dry
7. Wipe off the betadine with gauze at the area of needle insertion
8. Make a skin wheel with 1% lidocaine
9. Insert the 18ga introducer
10. Insert the spinal needle through the introducer until a “pop” is felt
11. Remove the stylet from the spinal needle and observe CSF flow
12. Aspirate CSF through the spinal needle to observe the CSF “swirl”
13. Inject 10.5-12mg 0.75% bupivacaine
14. Remove the needles from the patient’s back
15. Place the patient in left uterine displacement
16. Check the dermatome sensory level of the block

Question 12

what 3 things do you need to potentially drop in the sterile field prior to CSE?

Answer 12

two sterile tegaderm
espocan CSE tuohy needle
plastic syringe

Question 13

steps to a CSE placement 24

Answer 13

1. Open the kit
2. Drop the following on the field in sterile fashion:
   Two sterile tegaderm
   Espocan CSE Tuohy needle & 27ga spinal needle (optional if not in package)
   Plastic syringe on field (optional)
3. Put on sterile gloves
4. Prep the patient
5. Apply the sterile drape
6. Draw up everything while waiting for betadine to dry
7. Wipe off betadine with gauze at the area of needle insertion
8. Make a skin wheel with 1% lidocaine
9. Insert the Tuohy needle to the 3cm mark
10. Connect the loss of resistance syringe to the Tuohy needle
11. Guide the Tuohy needle into the epidural space with the loss of resistance technique
12. Remove the loss of resistance syringe from the Tuohy needle
13. Insert the spinal needle until a “pop” is felt
14. Remove the stylet from the spinal needle and observe CSF flow
15. Aspirate CSF and observe the CSF “swirl”
16. Inject the spinal anesthetic and remove the spinal needle
17. Insert the epidural catheter to the 16cm mark at Hub of Tuohy needle
18. Remove the Tuohy needle from the patient’s back
19. Pull the catheter back to the appropriate marking at the skin
20. Attach the epidural “snaplock adapter”
21. Secure the epidural catheter against the patient’s back with tegaderm
22. Throw the epidural catheter over the patient’s shoulder and allow the nurse to connect the catheter to the epidural pump
23. Place the patient in left uterine displacement if it’s a C-section
24. Check the dermatome sensory level of the block