DESIGN OPTIONS®

Description of Event or Problem

EPIDURAL WAS PLACED FOR PATIENT IN LABOR. AFTER OBTAINING LEVEL OF RESPONSE (LOR), CATHETER WAS THREADED INTO EPIDURAL SPACE WITHOUT DIFFICULTY. ASPIRATION WAS NEGATIVE FOR BLOOD OR CEREBROSPINAL FLUID (CSF). TEST DOSE WAS THEN ATTEMPTED TO BE ADMINISTERED VIA 20CC SYRINGE, BUT VERY DIFFICULT/IMPOSSIBLE TO FLUSH, MEETING A LOT OF RESISTANCE WHEN TRYING TO PUSH THROUGH THE EPIDURAL CATHETER. ALLIGATOR CLAMP WAS THEN REPLACED AND REATTEMPTED TO GIVE TEST DOSE VIA 20CC SYRINGE, AGAIN UNABLE TO FLUSH DUE TO RESISTANCE. 3CC SYRINGE WAS THEN USED TO ADMINISTER TEST DOSE SUCCESSFULLY BUT STILL WITH SOME RESISTANCE. TEST DOSE WAS NEGATIVE, THEN STARTED THE EPIDURAL BOLUS DOSE VIA PATIENT-CONTROLLED EPIDURAL ANALGESIA (PCEA) PUMP. EPIDURAL PUMP WAS UNABLE TO ADMINISTER THE DOSE, ALARMING DOWNSTREAM OCCLUSION BETWEEN PUMP AND PATIENT. EPIDURAL CATHETER WAS THEN FLUSHED USING 10CC SYRINGE WITH PRESERVATIVE-FREE (PF) SALINE, STILL DIFFICULT TO FLUSH THROUGH WITH A LOT OF RESISTANCE. EPIDURAL CATHETER WAS THEN PULLED BACK 1CM AND REATTEMPTED TO FLUSH WITH 10CC SYRINGE BUT AGAIN UNABLE D/T RESISTANCE. THE EPIDURAL CATHETER THEN HAD TO BE REMOVED ENTIRELY AND REPLACED WITH A NEW CATHETER. ONCE THE FIRST CATHETER WAS REMOVED, ATTEMPTED MANUAL FLUSHING OF THE CATHETER TO VISUALIZE ANY ISSUES WITH STILL LOT OF DIFFICULTY TO FLUSH, AND MINIMAL COMING THROUGH THE END OF THE TIP THAT WOULD BE IN THE EPIDURAL SPACE.