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Sp: Methods 1 > 3. Epidural Placement > Flashcards

3. Epidural Placement Flashcards

1
Q

what is the 1% lidocaine in the epidural kit for?

A

drawn up in 3mL syringe used for skin wheel

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2
Q

what is in the test dose lidocaine?

A

1.5% lidocaine and epi 1:200,000

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3
Q

what is the test dose lidocaine drawn up in?

A

20mL syringe

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4
Q

what is the test dose of lidocaine used for?

A

initial bolus of epidural local anesthetic right after the catheter is placed.

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5
Q

what is the purpose of the test dose?

A

to make sure the catheter isn’t in:
intrathecal
intravascular

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6
Q

how can you diagnose that the catheter is intrathecal?

A

immediate numbing of the legs

profound sympathectomy

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7
Q

how can you diagnose that the catheter is intravascular

A

immediate increase in HR and BP

tinnitus, metallic taste, numbness in mouth

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8
Q

what is the glass syringe used for?

A

(saline and air) loss of resistance technique when attached to the tuohy needle

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9
Q

what is an alternative to the glass loss of resistance syringe

A

plastic syringe with only air in it

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10
Q

what is the benefit of using saline in your loss of resistance syringe?

A

you can see the air bubble compressing in the syringe

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11
Q

what is the disadvantage for using saline in the loss of resistance syringe?

A

harder to diagnose a wet tap because the saline coming out of tuohy may be mistaken for CSF

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12
Q

If you do wet tap what will the CSF most likely do?

A

spray out of the tuohy needle

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13
Q

what is false loss of resistance

A

can be felt when off midline and enters paraspinous muscles

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14
Q

how do you know if it was a false loss of resistancE?

A

because you will have difficulty threading the epidural catheter

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15
Q

what is the cc amount of test dose?

A

5mL

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16
Q

what is a withdrawal filter

A

attached to syringe prior to drawing up local, filters out glass particles

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17
Q

what is the alternative to the withdrawal filter?

A

filter needle

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18
Q

what can you use if you forget to use a filter needle on the local?

A

injectate filter

attachef onto syringe

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19
Q

what syringe do you draw up the 1% lidocaine?

A

3mL syringe with 18ga (purple) needle

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20
Q

what needle do you use to inject the 1% lidocaine for the skin wheel?

A

25ga needle (blue)

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21
Q

what is the 22ga (grey) needle used for?

A

trick question, we don’t know

could be used as alternative to the skin wheel local

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22
Q

where do you put your needles on the epidural tray?

A

stick needles into the needle holder (red and has styroform inside)
prevents from recapping needle

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23
Q

what is the name and gauge of the epidural needle

A

tuohy needle

17ga

24
Q

what is the tuohy needle used for

A

attached to loss of resistance needle to find epidural space

the catheter is threaded through this needle

25
Q

how long is the tuohy needle?

A

11cm

26
Q

how many cm markings does the tuohy needle have?

A

8cm

27
Q

what detail of the tuohy needle decreases the chance of dural puncture?

A

the tip of the needle is curved

28
Q

what way should the bevel be pointed at?

A

upward

29
Q

what does left hand do during epidural?

A

placed against pts back and advances the needle

30
Q

what does the right hand do during epidural?

A

hold pressure on loss of resistance needle

31
Q

why do you only advance the needle with the left hand?

A

advancing with only one hand decreases the likelihood of wet tap

32
Q

what is the first thick mark on the epidural catheter?

A

5cm from distal tip

33
Q

what are the two consecutive thick marks on the epidural catheter?

A

10cm from distal tip

34
Q

what is the thick black bar on the epidural catheter?

A

11cm AND 12 cm from the distal tip

35
Q

what are the three consecutive thick marks on the epidural catheter?

A

15cm away from distal tip

36
Q

what piece allows the catheter to be hooked up to an infusion pump?

A

snaplock adapter attached at proximal end of catheter

37
Q

how much of the catheter should be in the epidural space?

A

5cm

38
Q

problem with threading catheter <5cm

A

more likely to pull out and stop working

39
Q

problem with threading catheter >5cm

A

increased likelihood of one sided block

40
Q

when the catheter is to the ___cm mark at the hub of the tuohy then it will be 5cm in the epidural space?

A

16cm

41
Q

how do you determine how fas the tuohy needle has been inserted?

A

look at the portion sticking out and count backward from 8

42
Q

what is the average depth from the skin to the epidural space?

A

4.5-5.5cm

43
Q

what is the range the depth from the skin to the epidural space could be?

A

3-9cm

44
Q

if the tuohy needle has been removed can the catheter be advanced further into the epidural space?

A

no

only withdrawn

45
Q

if the epidural space was 3cm deep what should the catheter read at the skin>?

A

8cm at the skin

46
Q

should you remove the catheter while it is still threaded through the tuohy? why or why not?

A

no because it could potentially shear off some of the catheter into the epidural space

47
Q

why should you insert the catheter further than the 16cm mark at the hub?

A

because when pulling the tuohy out it has the tendency to come out slightly, it ensures that 5cm are still in the epidural space

48
Q

what is the angle of the tuohy needle insertion for lumbar epidurals?

A

perpendicular

because the spinous processes are perpendicular to the skin

49
Q

what is the angle of the tuohy needle insertion for the thoracic epidurals?

A

slightly cephalad

because the spinous process are slightly slanted downward in the thoracic region

50
Q

what do you do if you apirate blood from the epidural catheter?

A

withdrawn 1cm, flushed and aspirated again

repeated (if necessary) as long as 3cm remain in epidural space

51
Q

which is the easiest approach? midline or paramedian?

A

midline

52
Q

paramedian approach

A

bigger interspaces but more advanced approach

53
Q

taylor approach

A

paramedian approach at L4-L5

54
Q

what approach offers the largest interspace possible?

A

taylor approach

55
Q

what are the two main complications with epidurals?

A 
unintentional intrathecal administration (high spinal)
unilateral block (catheter inserted too far)
56
Q

how can a unilateral epidural block be treated?

A

withdrawing catheter 1-2cm
patient lay on side that hurts
remove catheter and start over

57
Q

steps to epidural placement (19)

A
  1. Open the kit
  2. Drop a plastic syringe (optional) and 2 sterile tegaderm on the field
  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 Tuohy needle to ≈ 3cm mark
  10. Connect the glass or plastic LOR 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
  13. Insert the epidural catheter to the 16cm mark at the Hub of the Tuohy needle
  14. Remove the Tuohy needle from the patient’s back
  15. Pull the catheter back to the appropriate marking at the skin
  16. Attach the epidural “snaplock adapter”
  17. Give test dose through the injectate filter after properly aspirating
  18. Secure the epidural catheter against the patient’s back with tegaderm
  19. Throw the epidural catheter over the patient’s should and allow the nurse to connect the catheter to the epidural pump

Sp: Methods 1 (15 decks)

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