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    Default Did my first epidurals in about 18 months. Questions for seasoned epidural providers

    Background: My group, the Army guys, took over the OB floor at our community hospital when the budget cuts forced the "letting go" of our civilian contract group who previously staffed it. We have always done the scheduled C-sections so I have placed many SAB over this time period. So now we lost them and are losing one CRNA and our ologist and come June we will have 4 CRNA's covering the OR and OB floor. They decreased us from 3 rooms a day to 2 and longer hours scheduled to "help" with staffing issues. So the call guy covers pre-ops, breaks, emergencies, blocks, OB floor and the OR after 1500.

    First day as call guy. Told there was new admit, wanted epidural. Go to pre-op, walk through the door, dad looks at me and jumps up clapping. I'm thinking maybe he thinks I'm somebody else. Get to talking with pt, apparently last delivery she got an epidural, she was a difficult placement, and the CRNA got "rude" with her and Dad (according to them). Dad was happy I was not him. So I look at old record and see nothing other than LOR at 8 cm. go to do epidural, can feel absolutely nothing but fat (arrgh, why this for first epidural in so long). Any way start advancing needle, can never feel any appreciable ligament. I redirect slightly, same thing. I know I'm midline, the plunger has some moderate resistance but this is the softest ligament I ever felt (in the 50 plus I did in school I at least felt some resistance). I use minimum pressure on plunger and redirect slightly to left as she feels it on right and voila at 8 cm get real LOR. Threaded easily and epidural worked well. But I never felt comfortable just going to 8 or even where the needle was the entire time.

    Second epidural. Lady pushing 300 lbs. I felt good after last one working so well. Look at her records and it said last one LOR at 7 cm. Again feel absolutely no processes. Go midline at level of hips and advance. Feeling soft too but slightly better ligament than be fore around 6 cm, going slowly, hit bone at 7-8. Question out loud to OB nurse that I might need longer needle. Redirect a couple times finally get LOR at the hub, 9 cm. Threads and works fine.

    Questions -
    #1 for the ultra soft ligaments where normal plunger pressure leaks, what's the best, safest way to know where you are at and not spear the dura?

    #2 for the pregnant and/or obese, is there a BMI, weight, feel that automatically prompts you to use longer needle or do you wait til after attempting?
    Last edited by BigMAC - Army; 05-07-2013 at 03:37 PM.

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