Tunnelling catheters helps reduce the risk of infection but more importantly, keeps them in place if you need to keep them in place for more than 4-5 days.
For @uramalakia. To tunnel the catheter, you do not need either a Tuohy needle (especially with a metal stylet) or a spinal needle, this is unnecessary. 1. It is enough to take the same Stimuplex needle with a plastic stylet and, under aseptic conditions, under local anesthesia, inject it in the place where you expect the catheter to come out on the skin and direct it to the catheter that has already come out. We remove the plastic mandrel and, under aseptic conditions, pass the catheter inward through the cut of the needle and remove the needle. 2. For or against the skin bridge. It can be done either way. But! In those cases where the catheter is located in a very small and very mobile area (for example, the supraclavicular area), it is better without a bridge, the risk of catheter dislocation is much less. 3. Any catheter is a foreign body, the service life is up to 1 month, with very good care - 1.5 months; then, for various reasons, it is better to execute another block...
The evidence for or against a skin bridge is non-existent. I actually prefer to have a skin bridge. I have had cases where the catheter is buried under the skin completely and kinks, and cannot be removed easily unless you use a scalpel to cut the overlying skin and extract the catheter. PS: I do 200 catheters a year, and > 10 years of USG experience. Nice video.
We have had multiple incidents of peri neural catheters getting pulled out postoperatively. We have tried tunnelling, using lockets and even suturing the catheters. Can you share a video of how you secure the catheters ? Pajunk’s E-cath plus with Fixo cath or suturing the wings of the cath is the best thing that I have used but they are costly and also not readily available here.
There are several ways to do it, for sure. The trick is to NOT cut the catheter with the tuohy needle AND to not have a skin bridge. That’s why I like the stylet technique. You reliably get in the exact same hole (so no skin bridge) and you don’t risk cutting the catheter by driving a needle towards the unprotected catheter. Thanks for watching!
For @uramalakia.
To tunnel the catheter, you do not need either a Tuohy needle (especially with a metal stylet) or a spinal needle, this is unnecessary.
1. It is enough to take the same Stimuplex needle with a plastic stylet and, under aseptic conditions, under local anesthesia, inject it in the place where you expect the catheter to come out on the skin and direct it to the catheter that has already come out.
We remove the plastic mandrel and, under aseptic conditions, pass the catheter inward through the cut of the needle and remove the needle.
2. For or against the skin bridge. It can be done either way.
But! In those cases where the catheter is located in a very small and very mobile area (for example, the supraclavicular area), it is better without a bridge, the risk of catheter dislocation is much less.
3. Any catheter is a foreign body, the service life is up to 1 month, with very good care - 1.5 months; then, for various reasons, it is better to execute another block...
The evidence for or against a skin bridge is non-existent. I actually prefer to have a skin bridge. I have had cases where the catheter is buried under the skin completely and kinks, and cannot be removed easily unless you use a scalpel to cut the overlying skin and extract the catheter. PS: I do 200 catheters a year, and > 10 years of USG experience. Nice video.
We have had multiple incidents of peri neural catheters getting pulled out postoperatively. We have tried tunnelling, using lockets and even suturing the catheters. Can you share a video of how you secure the catheters ? Pajunk’s E-cath plus with Fixo cath or suturing the wings of the cath is the best thing that I have used but they are costly and also not readily available here.
i just use a 14G cannula and skip the needle to tuohy step. use the cannula cover to protect the puncture site
If I don't have a Tuhoy needle with a metal stylette, can I use a spinal needle instead of the stylette?
No need for stylet , skip that step ; use directly the needle equally effective
Faster
There are several ways to do it, for sure. The trick is to NOT cut the catheter with the tuohy needle AND to not have a skin bridge. That’s why I like the stylet technique. You reliably get in the exact same hole (so no skin bridge) and you don’t risk cutting the catheter by driving a needle towards the unprotected catheter. Thanks for watching!