Obstetric Anesthesia Core Knowledge Modules-Epidural Placement Checklist

Epidural Placement Checklist

Pdf Summary

The checklist reviews the sequence for epidural placement: prepare and check equipment and medications, establish a sterile field, and apply patient monitors. Identify the lumbar interspace using the iliac crests, prepare the skin with chlorhexidine, and administer local anesthetic.<br /><br />For needle placement, orient the Tuohy bevel upward and advance with controlled, repeated loss-of-resistance checks. The video describes saline for this technique; air is used only for the mannequin demonstration. After identifying the epidural space and noting its depth, thread the catheter, remove the needle carefully, connect the catheter, and set the intended skin marking. The example shown is 6 cm to the epidural space, with 4 cm of catheter in the space and 10 cm at the skin.<br /><br />Before the demonstrated test dose, aspirate for blood or cerebrospinal fluid. The dose is 3 mL of 1.5% lidocaine with epinephrine 1:200,000. Monitor heart rate and symptoms such as tinnitus, oral numbness, lightheadedness, or palpitations; assess leg movement over the next several minutes for signs of intrathecal placement. Finally, secure the catheter with a transparent dressing, keep depth markings visible, and check placement if the patient reports concerns.

Keywords

epidural placement

Tuohy needle

loss of resistance

lumbar interspace

chlorhexidine skin prep

local anesthetic

epidural catheter

test dose

lidocaine epinephrine

intrathecal placement