CSE'S josh Flashcards
CSE
currently being used in what sx’s
- orthopedic
- urological
- gyn
- post-op pain
CSE
offers both _____ and ____
analgesia
anasthesia
CSE
ehen can it be used
any situation where a spinal or epidural is planed
CSE
it offers the quick onset of a _______
wuth the flexability of an _______ catheter for prolonged procedures and/or post op pain
spinal
epidural
CSE
most commonly used needle
modified touhy with a “black eye”
Label
- Quincke-babcock
- Pitkin
- Greene
- Whiteacre
- Touhy
CSE
the needle used for CSE is designed to be slightly _____ than the epidural needle used. typically it is what size?
longer
4.5 inch spinal needle
Label
- Cauda Equina
- Dura
- Ligamentum Flavum
CSE
the other needle used today is what? but not used as much b/c there is a higher incidence of inadvertent dural puncture during placement since it is NOT rounded like the Tuohy
straight beveled Crawford
CSE TECH: 2 level
tell me the tech
- epidural cat is inserted 1st and tested so placement is confirmed
- then spinal is done one or 2 interspaces Below the epidural level
CSE TECH: 2 level
advatages
able to test epidural cath prior to injection of spinal
CSE TECH: 2 level
disadvantage
trauma and discomfort from multiple level insertion
CSE TECH: Single level
tell me steps
- insert epidural needle at appropriae space
- then usuing the epidural needls as a guide for the spinal needle
CSE TECH: Single level
advantages
- less tissue trauma
- less backache
- less morbidity
CSE TECH: Single level
disadvantage
- inability to test catheter
- (b/c spinal goes first)
CSE TECH: Single level
once epidural cath is placed, any fluid aspiratedmust be assessed to see if it’s CSF. how can you do this?
- CSF is warm to the touch
- CSF will form a precipitate if mixed with equal volume of Sodium thiopental
*
CSE TECH: Single level
any injection via the catheter must ONLY BE DONE after what? and you must aspirate every __-__ ccs while giveing epidural doses
- careful and diligent aspiration test
- 3-5 cc’s
CSE TECH: Single level
once spinal is done reassess your epidural needle placement how?
LOR
CSE TECH: Single level
how should you give the epidural dose and why?
- via catheter rather than the needle
- b/c your needle is right infornt of the dural hole
CSE TECH: Sequential
why was it designed?
to minimize hypotension effects
CSE TECH: Sequential
tech
- an epidural needle placed at selected IVS
- low dose (7.5mg hyperbaric Bupivacaine) spinal given
- epidural is placed quickly as possiable
- pt placed supine
- once spinal dose has set and level determined catheter is used to titrate the dose higher
- (1.5-2ccs per unblocked segment) untill desired effect is determined
CSE TECH: Sequential
advantages
minimizes hypotensive effect
CSE TECH: Sequential
disadvantages
- time concuming
- using each tech at 1/2 it’s potential
CSE:
although suitable for anytime either is used it is particulary suitable for what pt’s
obstetric pts
CSE:
in OB it was the tech employed to provide the “_____” epidural
walking
CSE:
the “walking epidural is typically accomplished by using what LA
0.0625% bupivacaine
CSE: tech and uses
Involves placement of epidural needle where?
L3-4 or
L4-5
CSE: tech and uses
usually the catheter is activated using _____-____% _____ followed by initiation of an infusion of _____-____% ______ @ __-__ mL/hr (w or w/o opiods)
- 0.125-0.25% bupivacaine
- 0.0625-0.125% Bupivacaine
- 10-12 mL/hr
Dispite the utility and flexability of the CSE tech, several concerns r/t it’s use exist. What are they
- Ability for the pt to SAFELY ambulate
- failure to obain SAB
- Catheter migration
- Metallic particles
- PDPH
- Infection
- Neuro injury
done
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