1. Have a dedicated block team
If you're starting a regional anesthesia program, begin by hiring and
training the very best staff. There's nothing wrong with the "everyone
does everything" mentality of ambulatory surgery centers, but when it
comes to a perineural catheter team, everyone should be specialized.
I recommend a dedicated block team and block nurse to help with
placing catheters. A one-to-one ratio of a block nurse to an anesthesia
provider tends to work best. Our block nurse helps with setting up
catheter trays, leading time-outs, educating patients, preparing local
anesthetics, completing documentation and assisting with block
placement.
While everyone on the team should be trained in placing CNBs, not
everyone needs to be an expert. Aim to have at least one senior mem-
ber on every block team. In our 8-OR facility, there's at least one expert
per block team who acts as part-clinician, part-educator when the
patient is receiving the block.
Your anesthesia staff can stay up-to-date about placing blocks by
attending lectures, visiting other facilities to watch experts, using online
resources like nysora.com, usra.ca and ultrasoundblock.com, and
seizing every opportunity they can to practice catheter placement.
2. Take advantage of ultrasound
I'm a firm believer that anesthesia providers should use ultrasound for
every catheter placement. Not only does it make the procedure more
efficient, but we're also starting to see data that show that there are
safety benefits as well, such as decreased incidence of vascular punc-
ture and decreased risk of systemic toxicity. It's also a big draw for
your facility. Many anesthesia providers, especially younger ones,
expect ultrasound to be available for block placement. This doesn't
mean that you need to run out and purchase a $100,000 machine. The
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