D E C E M B E R 2 0 2 0 • O U T P A T I E N T S U R
G E R Y . N E T • 11
Y
ou can use ultrasound to
identify landmarks and
assist in the placement of
an epidural, but it does not guar-
antee the catheter will end up in
the epidural space. That's why
loss-of-resistance training for the
gold standard landmark-based
technique is important. An inex-
pensive way to practice involves
grabbing a banana from the
break room and taping it to an
inflated surgical glove.
Advancing the large gauge,
blunt-tip Tuohy needle through
the banana peel mimics going
through the supraspinous and
interspinous ligaments, as well
as the ligamentum flavum. You'll
feel the loss of resistance once
the needle goes through the peel
and is in the banana itself, which
is what it feels like when the
needle passes through these liga-
ments and into the epidural
space. Moving the needle
through the back of the banana
and popping the glove simulates
entering the patient's spinal
space. This is known as a "wet
tap," and shouldn't happen.
Nadia Hernandez, MD
Texas Medical Center
Houston, Texas
nadia.hernandez@uth.tmc.edu
PLANTAIN PRACTICE
Peeling Back the Basics of Epidural Placements
LIKE A GLOVE This creative set-up is a fun and inexpensive way for anesthesia providers to sharpen their
epidural techniques.
Nadia
Hernandez