Spinal and CSE placement

Question 1

Marcaine concentration in spinal tray

Answer 1

2mL 0.75% vial

Question 2

Most common OB doses for spinal marcaine

Answer 2

1.4-1.6 mL (10.5-12mg)

Question 3

Steps to spinal placement (16)

Answer 3

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

Question 4

Which way should the bevel of the spinal needle be facing upon insertion to decrease the chances of PDPH?

Answer 4

Sideways prior to insertion

Question 5

Steps to CSE placement (24)

Answer 5

1. Open the kit
2. Drop 2 sterile tegaderm, Espocan CSE Tuohy needle and a 27ga spinal needle and plastic syringe (optional) onto the field
3. Put on sterile gloves
4. Prep the patient
5. Apply sterile drape
6. Draw everything up 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 Tuohy needle to 3cm mark, remove stylet
10. Connect LOR syringe
11. Guide Tuohy needle into epidural space with LOR technique
12. Remove LOR syringe
13. Insert spinal needle until a “pop” is felt
14. Remove stylet from spinal needle and observe CSF flow
15. Aspirate CSF through spinal needle and observe swirl
16. Inject spinal anesthetic and remove spinal needle
17. Insert epidural catheter to 16cm mark at hub of Tuohy needle
18. Remove Tuohy needle from patient’s back
19. Pull catheter back to 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 nurse to connect the catheter to the epidural pump
23. Place the patient in L uterine displacement if its a C-section
24. Check the dermatome sensory level of the block

Question 6

Do you open/use narcotics for CSE placement?

Answer 6

No, the epidural will provide post op analgesia