Spinal anesthesia: How to use Guide Needle - Regional Anesthesia Crash Course with Dr Hadzic
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- Опубліковано 22 лют 2021
- Spinal anesthesia: How to use Guide (Introducer) Needle. Regional Anesthesia Crash Course with Dr Hadzic
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Most people saying they saw CSF coming out of the introducer needle are seeing their local injection flowing out, not CSF. I generally don't "hub" the introducer needle as every anatomy is different and I'm sure plenty of anatomy out there with SAS at or less than 3cm from ligament, but still I use the introducer and insert the introducer to about 80-90% of its length. If after that if my spinal needle (pencan) is not advancing or meeting too much resistance, then I will take the spinal needle out and then hub the introducer to 100% and try again. I have actually had many patients who have thick skin and so much sub-q fat that the introducer wont even engage with the ligament. Or once it engages the skin/fat actually pull it back out. This can also be a problem. We then use a sterile and longer 5" hypodermic needle to replace the shorter introducer needle.
Great piece there👏👏
Thank you
Thanks
Paramedian approach without introducer is so much easier and faster, and you aren't in need to give local anesthesia and to use double puncture.
الله عليك يا دكتور محمد
Even with a blunt tip needle?
What needle?
Dr Hadzic im about to perform my first spinal today and i am thankful for this tip!
WOW .... what a coincidence, I'm having some major Spinal Surgery Today & my Doctors has same name as you !!
Hang on, wait a minute ..... "Dr Ra is that you ??? .......wtf "
@@HonestJunkie luckily if you are having spine surgery then you wouldn't get a spinal
the shallow placement of the introducer needle is fine, as long as you advance the introducer needle along with the spinal needle. That would provide the support that the spinal needle needs to reach deep targets.
Thank you so much for your feedback - that's a great point 💉! Greetings from NYSORA's team.
Won't the blunt needle bend if you introduce it together with the introducer as it being longer?
I rarely need the introducer. The 24 or 25 G needle can be negotiated through the tough ligament. It just needs practice. Furthermore less patient complains back pain owing to large gauge needle
@@hirondelleankara I presume that you are not a medical personal. If so it’s better you don’t watch videos like this. These are highly technical stuff and it’s irrelevant for the patient. Medicine is a science but unlike mathematic equations every problem doesn’t have a black and white answer. The decision of inserting needle fully or halfway depends on so many facts. So Mr. Ankara, leave the technical decisions for the experts to make and keep worrying about your hernia and whether or not it gonnna get strangulated
That is a myth... www.aana.com/docs/default-source/aana-journal-web-documents-1/449-452.pdf?sfvrsn=16c855b1_6&fbclid=IwAR3IrmztGBL-JBStbHFqY2wvDEjv6D0NcODWJ5vpQVoxZDLlVdonzURO2Fg
You would need the introducer for pencil point needles
We use blunt needles here so introducer definitely helps
He is talking about pencil point needles
You meant that I should introduce the whole length of introducer?! I always go paramedian approach and introduce the whole length of introducer unless the pt is so thin
@@hirondelleankara i used to give local anesthesia first then give spinal anesthesia
@@hirondelleankara no it isn’t painful it is the best for inguinal hernia much better than spinal
I’ve been doing this procedure for a while, moreover when using the Whitacre needle. And it’s so recommended for its great success rate. 👍🏻
Anesthesiologyst yes.
I always introduce half length as it is easy to redirect.
Ok, sir. Next time I shall correct myself
The logic in this video doesn’t hold true when performing a spinal anaesthetic in an obese patient where the subcutaneous fat depth may be greater than the length of the introducer. In such cases, the spinal needle is perfectly capable of passing through the ligaments without the aid of the introducer.
True but blunt tip spinal needle will certainly pose a problem while insertion without introducer.
Even in obese patient,introducer will cross the limits of Supraspinous and interspinous ligaments,so it helps with fine pencil point needles.
I've done a lot of sa puncures and twice happens that CSF flow freely throw the introducer. So the solution I adopt now is to introduce the introductor for 2 cm and after intoduce the spinal needle haft centimeter beyond the introducer and advace them together!
Hi Tropie! Thank you for sharing. And make sure you subscribe to this UA-cam channel - we have a lot more really interesting videos coming up soon.
How did CSF flow within 3 cm introducer needle when Dr Hadzic said you need 5cm to reach CSF?
@@MrLiehus once happned to me to find csf in a thin patient after introduction of 2,3 cm of spinal introducer, so the exceptions confirm the rule. But from that moment I use to do as I told!
Anyone knows if 30 gauge is enough for reaching and administrating stem cells ?
Hello dr
Can u please upload a video about intra articular lidocaine for anterior shoulder dislocation reduction
Hi Dr. Ali! great suggestion. We will definitely put this on our list. Greetings!
Actually I have reached intrathecal space once with introducer in less than 3 cm in one tiny woman for c section. I gave anesthetic through introducer😂 and small irrelevant postpuncture headache occur after two days
I got csf with my introducer before in a thin patient though 😂 definitely be careful
Are you sure it wasn't your local coming out? This is what most people see.
@Desflur it shouldn't leak out continuously if it's local and be warm and slippery.... 😂 But the patient was very very thin
👍👍👍
The problem with introducers is that they steal some of your potential depth which may be needed in obese patients.
2 mistakes I encountered in this video, as I'm just an anesthesia resident. A needle, regardless how tiny it is, NEVER curved in pts tissue.Once you go through the skin, the needle never curve ( at least not like a snake), actually if you support and stabilize the needle with both hand, you will never bend your needle. Yes I am talking abt no introducer method.
Second mistake the video has is, he said that introduced is short enough and no way can reach the subarachnoid space. And thatsbjust a not true. Last week, my attending came to me and told me that in o e of my college spinal, the CSF was dripping from the...INTRODUCER.
Now we have 100 kg man, hey I get it. But if you have 45 kg old lady, that introducer will definitely reach the SAH space. Period.
You are right. I also have seen spinal headaches with introducer puncture.
So you are saying that needles won't deflect?
associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2044.2002.02657.x?fbclid=IwAR1Sx8jqma3tQxHhot5f03pDbzJxp6hSdoXQsElG3xWuH4r-qyOn-kVfNXI
needles definitely deflect. No question about it unless very large gauge. Many practitioners will go about half way, then flip 180 degrees hoping to minimize bending curvature inaccuracy. introducers on thin patients can get CSF, but in my patient population that is never the case.
@@02hreblue30
Not only deflect but sometimes spinal needle takes zig zag shape if patient moves suddenly while needle is in SAS.
I would have been more happy to share the pic of zig zag shape of spinal needle when pt moves abruptly...but I don't know how to share it with