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    Guidelines For Obstetric Epidural Blood Patch NPS 5.4.06

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    grigmih
    An obstetric epidural blood patch may be considered for a post-dural puncture headache that is severe at 24-48 hours and not improving. It is usually performed after 48 hours, as success is reduced earlier. Infection risks require checking temperature and white blood cell count beforehand. The procedure requires two doctors, written consent, and full aseptic precautions. Approximately 10-20ml of blood is injected through the epidural needle, retaining 10ml for culture. The patient remains flat for two hours and is monitored for complications.

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    Guidelines For Obstetric Epidural Blood Patch NPS 5.4.06

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    grigmih
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    An obstetric epidural blood patch may be considered for a post-dural puncture headache that is severe at 24-48 hours and not improving. It is usually performed after 48 hours, as success is reduced earlier. Infection risks require checking temperature and white blood cell count beforehand. The procedure requires two doctors, written consent, and full aseptic precautions. Approximately 10-20ml of blood is injected through the epidural needle, retaining 10ml for culture. The patient remains flat for two hours and is monitored for complications.

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    Guidelines for Obstetric Epidural Blood Patch NPS 5.4.06

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    An obstetric epidural blood patch may be considered for a post-dural puncture headache that is severe at 24-48 hours and not improving. It is usually performed after 48 hours, as success is reduced earlier. Infection risks require checking temperature and white blood cell count beforehand. The procedure requires two doctors, written consent, and full aseptic precautions. Approximately 10-20ml of blood is injected through the epidural needle, retaining 10ml for culture. The patient remains flat for two hours and is monitored for complications.

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    © All Rights Reserved
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    Download as doc, pdf, or txt
    171 views2 pages

    Guidelines For Obstetric Epidural Blood Patch NPS 5.4.06

    Uploaded by

    grigmih
    An obstetric epidural blood patch may be considered for a post-dural puncture headache that is severe at 24-48 hours and not improving. It is usually performed after 48 hours, as success is reduced earlier. Infection risks require checking temperature and white blood cell count beforehand. The procedure requires two doctors, written consent, and full aseptic precautions. Approximately 10-20ml of blood is injected through the epidural needle, retaining 10ml for culture. The patient remains flat for two hours and is monitored for complications.

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    © All Rights Reserved
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    HEREFORD HOSPITALS NHS TRUST

    Department of Anaesthesia & Critical Care


    Obstetric Anaesthesia and Analgesia Guidelines
    GUIDELINES FOR OBSTETRIC EPIDURAL BLOOD PATCH
    To be considered if post-dural puncture headache (+/- associated symptoms) severe
    at 24-48 hours post dural puncture and not improving (accidental dural puncture
    with Tuohy needle or following deliberate spinal anaesthetic). Usually carried out
    after 48 hours as reduced success rate if performed earlier. Early blood patch via
    epidural catheter is not recommended as catheter tip position is unknown, success
    rate is less and procedure may be unnecessary. We do not perform prophylactic
    blood patching, as this may be an unnecessary procedure.
    DO NOT perform if any possibility of local or systemic infection because of risk of
    epidural abscess or meningitis.
    Check temperature and white blood cell count a short time before proposed blood
    patch.

    Decision to perform made only by consultant anaesthetist after full


    consideration of circumstances.
    Full explanation of options to patient including purpose and side
    effects/complications, e.g. backache, failure, further dural puncture and
    epidural abscess
    Written consent from patient
    Blood patch performed in room on delivery suite
    Requires two doctors
    anaesthetist performing blood patch
    2nd doctor to perform venepuncture
    Full aseptic conditions for epidural insertion and iv cannula insertion/drawing
    of blood is vital. Both doctors wearing gown, gloves, mask, hat
    Insertion of intravenous cannula in large arm vein for drawing of blood
    Lumbar epidural performed at convenient space
    The second doctor then draws 30ml blood through the IV cannula (or by direct
    venepuncture)
    Anaesthetist slowly injects approximately 10-20ml blood through Tuohy
    needle, retaining 10ml for blood culture (5ml for each of a pair of blood culture
    bottles)
    Stop epidural injection of blood if mother experiences back or leg pain
    Place dressing over epidural site
    Patient to lie flat
    Send blood culture bottles to Microbiology laboratory
    Patient is allowed to get up after two hours
    May go home next day if asymptomatic after anaesthetic review and
    discussion with consultant anaesthetist, and advised not to lift heavy objects
    for one week.

    Contact patient next day at home, the following day and at one week to check
    no recurrence of PDPH symptoms or back/leg/sphincter problems. Record
    consultations in notes.
    Mother must be instructed to contact Maternity Unit/Obstetric anaesthetist
    immediately if any related problems
    Follow-up blood culture results to check no growth. If positive culture, results
    should be treated with caution and immediate Microbiology consultant advice
    should be sought. Ask patient to return to hospital immediately for
    consultation and appropriate treatment.

    Note: History of previous epidural blood patch is not a contra-indication to


    subsequent epidural or spinal block.
    Microbiological aspects of these Guidelines agreed with Dr. S. Edmondson,
    Consultant Microbiologist, Hereford Hospitals NHS Trust.

    References:Guidelines for Obstetric Anaesthetic Trainees, Cardiff and Vale NHS


    Trust.
    Birmingham Womens Hospital Guidelines for Obstetric Anaesthesia
    2005.
    Obstetric Anaesthesia Guidelines, King Edward Memorial Hospital, Perth,
    Western Australia 2005.
    Sharpe P. Accidental Dural Puncture in Obstetrics. BJA CEPD News
    2001;Vol1, No.3, 81-84.

    Dr. Nigel Salmon : 05.04.06


    Review Date:
    April 2008

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