Tag Archives: tip

Rectus Sheath Catheters

Equipment:

Catheter pack or Epidural pack

20ml of 0.25% l-bupivicaine for each side

 

Using US identify rectus muscle. Above umbilicus. Transverse plane if necessary.

Then view in longitudinal/sagittal plane

Enter as close to midline as possible, but alow enough clearance for dressing and wound.

Identify plane. Hydrodissect using saline and create space

Thread catheter as far as it goes

Then attach filter etc and inject remaining LA to see spread

Dressing pack – catheter to be exiting caudally. May use glue.

 

Attach infusion devise.

Link:

http://e-safe-anaesthesia.org/e_library/09/Ultrasound_guided_rectus-sheath_block_Update_2010.pdf

Tunnelled epidural catheter

Additional kit:

Abbocath

Scalpel

18G (‘green’) needle & syringe

 

Procedure:

After insertion of epidural, withdrawn Thouhy by 1-2 cm so that it remains in patient but outside of epidural space

Small nick in skin adjacent to epidural needle, on side of which epidural catheter is to be tunnelled

Local anaesthetic using green needle in subcut plane laterally

Apply a slight curve in abbocath needle

Then local anaesthetic using abbocath

Exit at exit site of epidural catheter. Use plastic tube to apply tension to skin to help this. Do not exit too far away otherwise will struggle with dressing.

Cut off proximal wide part of abbocath

Pass epidural catheter through abbocath

Then remove abbocath

Pull back epidural to correct position

Then pull through tunnel

Glue the two skin incisions

Apply dressing

Airtraq tips

In a situation where the view is good but difficulty is encountered passed ETT between the cords consider the following:

Manoeuvring Airtraq (+/- head/airway) e.g. ‘drop’ it into pharynx to align angles better

Positioning of the glottis ‘target’ towards bottom right of screen

Use of bougie or wide bore NG tube (with ETT railroaded)

Alternative ETT e.g. standard instead of RAE