Using saline is the LOR. You have the choice to use air, saline, or both...typically, I'm more comfortable using saline and maybe a bubble or two of air.
Many catheters have a thicker mark around 11cm from the tip corresponding to the epidural needle length (with insertion adapter) - so you know when the tip of the catheter leaves the needle and enters the epidural space. Therefore you can insert the catheter to about 6cm epidural-space-length (and avoid inserting it to 15cm which is usually way too much, which can - amongst other problems - cause neurological issues and deviation from planned epidural location), and after removal of the needle (which usually pulls the catheter out a bit) you can readjust the length to about 4cm epidural-space-length.
we don´t have to, but we definitely need to flush the filter with local anesthetic, otherwise it will contain about 1-2ml of air... It´s a way of testing if the catheter is patent - but the failure rate of modern catheters is extremely low. Flushing it will prevent instillation of air in the epidural space (which is not harmful) or epidural veins (which can be harmful, therefore you need to aspirate and check for blood return first before injecting fluids). If you flush with NaCl your first bolus of local anesthetic will be diluted (usually not a problem).
Great video, thank you! But you omitted aspirating (without the filter!) the catheter to check for blood return after you have pulled it into the final position.
Thank you
Salam sir, sir what's the procedure of being anesthetist in Australia? I have done my graduation in anesthesia.
Is saline better den LOR?
Using saline is the LOR. You have the choice to use air, saline, or both...typically, I'm more comfortable using saline and maybe a bubble or two of air.
Many catheters have a thicker mark around 11cm from the tip corresponding to the epidural needle length (with insertion adapter) - so you know when the tip of the catheter leaves the needle and enters the epidural space.
Therefore you can insert the catheter to about 6cm epidural-space-length (and avoid inserting it to 15cm which is usually way too much, which can - amongst other problems - cause neurological issues and deviation from planned epidural location), and after removal of the needle (which usually pulls the catheter out a bit) you can readjust the length to about 4cm epidural-space-length.
Why do we have to flush the catheter?
we don´t have to,
but we definitely need to flush the filter with local anesthetic, otherwise it will contain about 1-2ml of air...
It´s a way of testing if the catheter is patent - but the failure rate of modern catheters is extremely low.
Flushing it will prevent instillation of air in the epidural space (which is not harmful) or epidural veins (which can be harmful, therefore you need to aspirate and check for blood return first before injecting fluids).
If you flush with NaCl your first bolus of local anesthetic will be diluted (usually not a problem).
Great video, thank you!
But you omitted aspirating (without the filter!) the catheter to check for blood return after you have pulled it into the final position.