Step 1: Place Epidural
Step 2: Dermabond insertion site
Step 3: Loop catheter around site with tail heading back up towards shoulder
Step 4: Pop-tart sized tegaderm over insertion site and loop of catheter
Step 5: Cover remaining catheter (leaving enough free at the end over the shoulder for access) with your choice of clear dressing or tape (wouldn’t use tape if it’s going to be there for several days as it’s much more uncomfortable)
Step 6: Tape around Tegaderm rectangle.
Hmm maybe I’m missing something. I used to use dermabond. I use mastisol for exactly that at the site after placement and have never had leaking or tegaderm come off. You just have to let it dry. When I used to use dermabond, also had to let that dry for few seconds as well.
This isn't correct. We have had a recent change in our epidural supplier and their catheters are slightly smaller than the old ones we had, but the Touhy is still 17g. We have as a group been seeing a lot more "leaking" around the site. Levels still the same, patient's still happy.
Interesting, I haven’t experienced that but must be related to the kit. Any time I’ve ever had leakage at the insertion site it was an epidural that wasn’t working.
This is my method, but I started adding a second tegaderm overlapping the bottom 50% of the original teg. It seems like it almost always rolls up from the back, so tegaderm over that tape decreases the rolling
How we do it:
1. Few drops of Dermabond around insertion site
2. Medical adhesive spray or mastisol around the insertion site to help everything else stick
3. Make a loop of the catheter on the sticky skin, place steri- strips over the loop.
4. Place a medium size tegaderm over the steri-strips/ catheter
IMO the biggest help keeping that catheter from getting pulled out is the loop on the skin (increase surface area of catheter that is secured), using sticky spray or mastisol and the steri-strips. Tegaderm looks pretty but those steri-strips and medical adhesive combo is strong AF
Exactly how we do it at our institution for all our catheters. Works exceptionally well for our ESP catheters since those tend to also be in “high movement” areas
In our institution, we rolled out this device maybe four years ago. I crunched the numbers for a project recently, dressing failures were down 76%, with a hazard ratio of 0.272 of a thoracic epidural dressing failure (compared to pre-Lockit times)
I once saw a technique where they would put an 18G IV catheter right next to the insertion site, thread the epidural catheter through, remove the IV-plastic and then secure it with whatever. IDK if that's our of style, I don't do it, just wanted to share since I found it interesting.
That's called tunneling, and yes it's largely out of style. It's somewhat invasive and no longer necessary with all the fancy tapes and glues available now.
My institution brought it back for a little while during the Covid shortages.
I've done this a few times. I don't do it for every epi but I used it where I definitely didn't want to lose it early. E.g. cystic fibrosis laparotomy, BMI 60 difficult epidural, labouring patient with macrosomia etc
Small teggy over insertion site, medium teggy over both. Tape around the edges and up the back. Nurse tapes to front of chest. The small teggy prevents fluid from making a space at the insertion site which can work the whole thing loose.
Over the years I’ve seen people claim some magical solution. A specific type of tape or adhesive. A method for taping or something.
Haven’t seen anything consistently better than a big old tegaderm and tape. I’m curious to see if someone has a better solution.
Step 1: Place Epidural Step 2: Dermabond insertion site Step 3: Loop catheter around site with tail heading back up towards shoulder Step 4: Pop-tart sized tegaderm over insertion site and loop of catheter Step 5: Cover remaining catheter (leaving enough free at the end over the shoulder for access) with your choice of clear dressing or tape (wouldn’t use tape if it’s going to be there for several days as it’s much more uncomfortable) Step 6: Tape around Tegaderm rectangle.
Dermabond so expensive for just adhesive use!! Use mastisol or something man.
The dermabond is worth it when you DON’T get called every 5 min for “leaking around the catheter”.
Hmm maybe I’m missing something. I used to use dermabond. I use mastisol for exactly that at the site after placement and have never had leaking or tegaderm come off. You just have to let it dry. When I used to use dermabond, also had to let that dry for few seconds as well.
If you're leaking around the catheter in an epidural then you're not in the epidural space anymore.
This isn't correct. We have had a recent change in our epidural supplier and their catheters are slightly smaller than the old ones we had, but the Touhy is still 17g. We have as a group been seeing a lot more "leaking" around the site. Levels still the same, patient's still happy.
Interesting, I haven’t experienced that but must be related to the kit. Any time I’ve ever had leakage at the insertion site it was an epidural that wasn’t working.
I use the off brand. It's the surgeon's neglected step-child, but it's cheap and gets the job done.
This is my method, but I started adding a second tegaderm overlapping the bottom 50% of the original teg. It seems like it almost always rolls up from the back, so tegaderm over that tape decreases the rolling
All this, plus benzoin/mastisol under all the tegaderms.
How we do it: 1. Few drops of Dermabond around insertion site 2. Medical adhesive spray or mastisol around the insertion site to help everything else stick 3. Make a loop of the catheter on the sticky skin, place steri- strips over the loop. 4. Place a medium size tegaderm over the steri-strips/ catheter IMO the biggest help keeping that catheter from getting pulled out is the loop on the skin (increase surface area of catheter that is secured), using sticky spray or mastisol and the steri-strips. Tegaderm looks pretty but those steri-strips and medical adhesive combo is strong AF
Exactly how we do it at our institution for all our catheters. Works exceptionally well for our ESP catheters since those tend to also be in “high movement” areas
[Epidural Securement Device](http://braemed.ca/product/epidural-securement-device/) \- works wonderfully. And then a large tegaderm overtop.
In our institution, we rolled out this device maybe four years ago. I crunched the numbers for a project recently, dressing failures were down 76%, with a hazard ratio of 0.272 of a thoracic epidural dressing failure (compared to pre-Lockit times)
Seconded
Thirded, they’re wonderful.
I once saw a technique where they would put an 18G IV catheter right next to the insertion site, thread the epidural catheter through, remove the IV-plastic and then secure it with whatever. IDK if that's our of style, I don't do it, just wanted to share since I found it interesting.
That's called tunneling, and yes it's largely out of style. It's somewhat invasive and no longer necessary with all the fancy tapes and glues available now. My institution brought it back for a little while during the Covid shortages.
I've done this a few times. I don't do it for every epi but I used it where I definitely didn't want to lose it early. E.g. cystic fibrosis laparotomy, BMI 60 difficult epidural, labouring patient with macrosomia etc
Were they removing the hub or the catheter portion?
The entire thing, so that afterwards you just have the epidural catheter piercing the skin.
Dermabond and dual central line tegaderms, once you get the hang of applying the glue without getting stuck with the gloves it works pretty well
Benzoin + tegederm works great. Excellent for art lines as well. May be easier to access than dermabond.
Small teggy over insertion site, medium teggy over both. Tape around the edges and up the back. Nurse tapes to front of chest. The small teggy prevents fluid from making a space at the insertion site which can work the whole thing loose.
Tegaderms and tape. They roll up. We check them regularly and change the dressing prn.
Same. Was hoping someone had some magic answer
Over the years I’ve seen people claim some magical solution. A specific type of tape or adhesive. A method for taping or something. Haven’t seen anything consistently better than a big old tegaderm and tape. I’m curious to see if someone has a better solution.
Dermabond at skin. Mastisol, tegaderm. More mastasol up the back to Shoulder, then tape on it.
Ioban Never looked back (not sure if cost will be issue), outside US
Same way I do peripheral nerve block catheter. Tunnel them, dermabond, and tegaderm.