Assemble equipment for epidural placement.
Explain procedure and reassure patient. Sedation as appropriate.Patient positioning is critical for successful placement. Instruct the patient to round his/her back to facilitate spinal placement.
A. Assemble equipment for epidural including saline for loss of resistance syringe and local anesthetic for skin wheal. B. The patient should be instructed to sit with his/her back rounded in order to open the spaces between the spinous processes to facilitate placement of spinal anesthesia.
Examine surface anatomy of the patient’s back. Identify the spinous processes on the top of the iliac crests (L4 spinous process).
Sterile prepare the back widely around the L4-5 interspace.
C. The surface anatomy of the back can be examined for spinous process landmarks. The superior margin of the iliac crests can be palpated and represent the approximate level of the L4 spinous process. D. Sterile prep the back with sterile prep solution widely around the L3-4 or L4-5 interspace.
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