Document Detail


Laboratory evaluation of single-lumen, dual-orifice combined spinal-epidural needles: effects of bevel orientation and modified technique.
MedLine Citation:
PMID:  9667343     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVES: To evaluate the success rate of the spinal needle exiting through the spinal needle orifice in two commonly available single-lumen, dual-orifice combined spinal-epidural (CSE) needle kits, and to study the effects of the epidural needle bevel orientation and the modified insertion technique on its success rate.
DESIGN: Prospective, randomized study.
SETTING: Laboratory.
EQUIPMENT: Two types of single-lumen, dual-orifice CSE needle kits: CSE-Q kit and CSE-S kit.
INTERVENTION: 20 anesthesiologists and nurse-anesthetists were assigned to select randomly from the two types of CSE kits (CSE-Q and CSE-S). The epidural needle was then placed into a foam device simulating a patient's back and the associated spinal needle was inserted through the epidural needle with the epidural needle bevel oriented randomly upward, downward, left, and right, respectively. The procedures were performed before and after the modified technique was used. The modified technique consisted of (1) aligning the orifice/bevel of the spinal needle in the same direction as the epidural needle bevel, and (2) gently bending the hub of the spinal needle in the direction of the epidural needle bevel while advancing the spinal needle.
MEASUREMENTS AND MAIN RESULTS: Success rate of the spinal needle exiting through the spinal needle orifice was measured. Data were collected from 1600 attempts. The modified technique improved the success rate of spinal needle exiting through the spinal needle orifice from 67% to 94 % for the CSE-Q kit and 50% to 81% for the CSE-S kit. Upward orientation of the epidural needle bevel further improved the success rate to 96% and 91% for CSE-Q and CSE-S kits, respectively.
CONCLUSIONS: The spinal needle did not always exit through the spinal needle orifice in the CSE kits tested. CSE-Q kits performed better than CSE-S kits. Under the study conditions, the modified technique and the upward orientation of epidural needle bevel significantly improved the success rate of the spinal needle exiting through the appropriate spinal needle orifice.
Authors:
P H Pan
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of clinical anesthesia     Volume:  10     ISSN:  0952-8180     ISO Abbreviation:  J Clin Anesth     Publication Date:  1998 Jun 
Date Detail:
Created Date:  1998-09-17     Completed Date:  1998-09-17     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  8812166     Medline TA:  J Clin Anesth     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  286-90     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0695, USA.
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MeSH Terms
Descriptor/Qualifier:
Anesthesia, Epidural / instrumentation*
Anesthesia, Spinal / instrumentation*
Clinical Laboratory Techniques*
Evaluation Studies as Topic
Humans
Needles / standards*
Prospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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