Epidural Placement

Question 1

Test dose lidocaine concentration in the epidural tray

Answer 1

1.5% lido with 1:200,000 epi

Question 2

Lidocaine dose for numbing in the epidural tray

Answer 2

1%

Question 3

Length of Tuohy needle + the hub

Answer 3

11cm

Question 4

The bevel of the Tuohy needle should be pointed (up/down) upon insertion

Answer 4

Up to decrease chance of puncturing the dura

Question 5

How far should the epidural catheter be advanced into the epidural space?

Answer 5

5cm

Question 6

The catheter is more likely to pull out and stop working when the catheter is threaded

Answer 6

<5cm

Question 7

The likelihood of a one sided block increases when the catheter is threaded

Answer 7

> 5cm

Question 8

The average depth from the skin to the epidural space

Answer 8

4.5-5.5cm

Question 9

Needle angle for lumbar blocks

Answer 9

Perpindicular

Question 10

Needle angle for thoracic blocks

Answer 10

Slightly cephalad

Question 11

What should you do if blood is aspirated from the catheter?

Answer 11

Withdraw 1cm, flush with saline and aspirate again

Question 12

What should you do if blood is still aspirated when the catheter is only 3cm in the space?

Answer 12

Remove the catheter and start over

Question 13

Complications of epidural placement

Answer 13

1. Unintentional intrathecal administration

2. Unilateral block epidural block

Question 14

Steps to epidural placement (19)

Answer 14

1. Open the kit
2. Drop 2 sterile tegaderms on the field
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 the betadine with gauze at the area of needle insertion
8. Make a skin wheel with 1% lidocaine
9. Insert Tuohy needle to about 3cm mark (remove stylet)
10. Connect the loss of resistance syringe to the Tuohy needle
11. Guide the Tuohy needle into the epidural space with the LOR technique
12. Remove the LOR 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
    15/16. Pull the catheter back to the appropriate marking at the skin
    15/16. Attach the epidural “snaplock adapter”
15. Give a 5mL test dose through the injectate filter after properly aspirating to rule out intravascular or intrathetcal placement
16. Secure the epidural catheter against the patient’s back with tegaderm
17. Throw the epidural catheter over the patient’s shoulder and allow the nurse to connect the catheter to the epidural pump