As the saying goes, how can you stand by the river without getting your shoes wet. Doing epidural anesthesia every day will happen to a variety of things. Among them, the inability to pull out the catheter is a situation that everyone has encountered.
Usually, when I watched the big guy on the stage talk about how to deal with it, I understood it at the time and thought it was very simple. However, once I encountered it, I was stunned for the first time. When you are in a hurry, you will sweat on your forehead.
Regarding the epidural puncture technique, we have to accept that the predecessor technology of decades ago was very powerful. Nowadays, the larger the hospital, the more the epidural technique may be degraded.
So, if the epidural catheter can't be pulled out, how did the predecessors deal with it at that time?
1. Patients caused by muscle spasm: First of all, the patient's ideological work should be done to eliminate the tension factors, so as to prevent the contraction of the sacrospinous muscles on both sides and increase the difficulty of extubation. This can be followed by topical massage, light percussion or warm compresses, or occlusion with 0.5% procaine, or acupuncture.
Note: There was also procaine at that time,
After that, a 90 mm long acupuncture needle was inserted into the midline of the spine at an angle of 75 degrees at an angle of 75 cm at 1.5 cm next to the vertebral space where the catheter is located (bilateral), and then the twisting, turning, lifting and insertion were staggered with a frequency of 150~200 times/min. When the patient feels that the needle is tight, and the patient complains of soreness, numbness, swelling and heaviness, the catheter can be gently pulled out.
At that time, some people also proposed to use muscle relaxants, but the operation and management are complicated, so it is not suitable as the first choice, and should not be used unless necessary.
If possible, the patient can be returned to the ward with the catheter and instructed to lie flat before being removed after 24 hours.
2. For those who are caused by catheter knotting, if the catheter knot is not large, the skin can be pulled out when loosened, and for some extubated people who are extremely sleepy, even if they are massaged, closed, and injected with local anesthetic in the catheter, there is still a clinical situation of breaking into the body.
For this purpose, 10 mI of normal saline stored in the refrigerator can be injected through the catheter. Because the plasticity of the catheter can be stabilized by cold, the catheter will no longer be thinned, the catheter will no longer be extended, the surrounding tissues will be relatively cold and contracted, and the friction between the tube wall and the tissue will be reduced, which can increase the extubation force without breaking the catheter.
It is important to note that today's materials may become brittle when exposed to cold.
If it still does not work, the wire die insertion method can be used, and the sterilized wire die can be inserted into the catheter and pulled out together with the catheter. This cylinder is easy to use and increases the toughness and tension of the catheter.
3. Due to the quality of the catheter: the puncture needle can be used to guide the method, that is, the puncture needle bevel is etched and polished, the paraffin sleeve is coated inside and outside, the catheter is cut at a distance of 15 cm from the skin, under aseptic operation, after sufficient local anesthesia, the catheter is inserted from the needle mouth, and then pulled out from the needle tail, and the catheter is gently straightened, so that the puncture needle is guided by the catheter to enter again through the original puncture hole, and the needle should be tried to be extubated while entering the needle.
4. Caused by deviation of puncture direction or narrowing of the vertebral space: emphasize the restoration of the position at the time of puncture, if it is still unable to be pulled out, you can also choose to use the steel wire core insertion method to return to the ward with a tube, and pull it out after 24 hours.
What do you think? Seeing the handling of the predecessors, is it very admirable and incredible?
If we look at it today, maybe some of the methods are wrong. However, in the circumstances of the time, everything was groping, and this was the necessary stage of scientific and technological progress.
Please leave this article in your circle of friends, so that more anesthetic friends can see it, so that everyone can understand this important history.
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