Hello SRNAs out there. I just realized haven’t posted much for SRNAs lately. So, this is a long overdue post for you who just started doing spinals in either OR or OB.
It has been almost 3 years since I got in my first spinal as a student. I feel that it is time for me to write a post on this topic. I am not sure about you, but I did have some hard time with my success of spinal placement initially. Looking back, I felt that what I learned in the classroom didn’t connect the dot in clinical at the beginning, and it took me a little while to figure things out. The spinal placement is a hands-on technique, same as epidural placement. So if you haven’t got comfortable with your spinal, don’t sweat it. IT TAKES TIMES!
What When you start feeling the spinous processes, you will notice a dip or indentation with your fingers in between the spinous processes. That is where your local needle should inject indicated as blue line shown in above picture. Once you identify the spot, put x mark on the skin where you will inject your local. Take your time with your local needle as finder needle. If you feel the bone with your local needle, change the angle of the needle and redirect. Before you pull out your local needle, have your intruducer ready right next to your finder needle, so you won’t forget where the spot/angle should be. Look for butt crack as a midline mark if you can’t feel the spinous processes in obese patients. You can also start from the cervical spine and draw the line down the spine.
Once you find the space where you want to inject your local, step back and make sure patient is positioned properly. If patient is short and/or obese, positioning would play a crucial role in getting your spinal in. Don’t rush to get the procedure started. Make sure patient is positioned properly. Your preceptor will be pleased that you take your time to position the patient instead of rushing into the procedure and having hard time getting the spinal in.
If you keep hitting os but the depth of your needle is where you would expect to see CSF, redirect your needle at different angles (small changes of angles). cephalad, parallel or caudad. If you hit os with shallow depth but you are not hitting the spinous processes, you are probably not mid-line. You can ask patient if she is feeling left, right or midline. In addition, insert your spinal needle slowly. You need to raise your awareness of tactile sensation and over time you will know by feel that the needle is in the correct position.
Ask help as needed. You can learn by observation as well. Watch your preceptor and see how she/he finds the space and how to use the finder needle. One thing a SRNA often forgets is that you can learn a lot from how other people do their anesthesia. Don’t feel frustrated that you didn’t get your spinal in. Rather, watch and learn so you can succeed with your spinal next time.
If you have any particular topic/techniques you would like me to discuss, please shoot me an email!