Occasionally a catheter intended to be inserted into the epidural space is discovered to be intrathecal. Ideally when this occurs, the catheter is removed and another epidural insertion is attempted.
In some situations the decision is made to deliver analgesia via the intrathecal catheter. Examples include:
- Great difficulty inserting an epidural is anticipated (perhaps multiple attempts have been made during the insertion, the patient is morbidly obese, etc.)
- The patient is coagulopathic
- Label the catheter as intrathecal
- Start the infusion when any existing motor block has resolved
- Infuse Bupivacaine at a starting dose of 1mg/hr
- Suggested solution: Bupivacaine 0.25% @ 0.4ml/hr
- Titrate by 0.1ml/hr increments
- If a bolus is required for inadequate analgesia, 1ml of Bupivacaine 0.25% (2.5mg) is often adequate.
- SCM ORDERS (Epic Orders hopefully coming):
- Enter the infusion order in SCM via the anesthesia department order set under the heading "Intrathecal Infusions". Then select " Intrathecal Tunneled Catheters". There is a type-in menu titled:
- "intrathecal additives" to select desired drug and concentration.
- ***Three orders in this set should be deselected: the cefazolin, the abdominal binder, and bedrest orders should not be entered (these are intended for our oncology population with tunneled IT catheters).
- These catheters should be watched carefully for signs of infection.
- Removal should be considered by POD #3.