– POSITION WELL
– count up from L2/3 and also down from C7 spinous process (major prominence in neck) to identify level
– if under GA try 3 different spaces before resorting to para-median approach as patient is not awake to be a marker of danger
– maintain thumb of non-needling hand on spinous process above space
– feed epidural to that natural curve tends to take it cephelad
– tunnel catheter (less movement, earlier marker of infection):
- nick in skin prior to needling
- feed 16G gelco sub-dermally in lateral direction approx 5cm
- cut off end obliquely
- pass through catheter without touching skin
- CAREFUL NOT TO CUT EPIDURAL CATHETER
– PM @ LGH