Based on these laboratory investigations, we conclude that an epidural catheter can be placed inside the dura through a Tuohy needle
, albeit in dehydrated specimens.
The 18-gauge Tuohy needle
and epidural catheter (Perifix[R] Standard Epidural Catheter, B.
18G Tuohy needle
is introduced through the mark and advanced directly perpendicular to the skin, until contact with transverse process of the particular vertebra.
A 5.1 cm insulated Tuohy needle
(Contiplex Tuohy, B.
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A T10/11 thoracic epidural was placed using a long (11 cm) Tuohy needle
(loss of resistance to saline at 10 cm) and a single-shot spinal was performed at L4/5 using a long Tuohy needle
as an introducer (loss of resistance to saline at 9.5 cm) for a Gertie Marx[R] spinal needle (25 gauge, 150 mm).
This insulated Tuohy needle
can then be used as a stimulating needle by attaching it to the 'crocodile' caliper of a nerve stimulator as is shown in Figure 1.
With the patient in the sitting, flexed position, an 8 cm 18 gauge Tuohy needle
was used to locate the epidural space at a lumbar interspace that was thought to be L3/4.
Following dural puncture, 265 respondents (64%) indicated that they "would usually remove the Tuohy needle
and resite" The most common reason for this decision was concern regarding the safety of intrathecal catheters (ITC) (n=236, 89%), in particular, the risk of misuse (n=182, 70%).
An attempt was made to insert the epidural using a 16 gauge Tuohy needle
at the T10-11 interspace, but this was complicated by a dural puncture as diagnosed by the free flow of cerebrospinal fluid (CSF).
Twenty minutes were required to locate the epidural space at a depth of 10 cm using a Portex 16 gauge 11 cm Tuohy needle
(Smiths Medical, U.K.).
To avoid direct trauma to the plexus on initial needle placement, an insulated Tuohy needle
(Contiplex Tuohy, BBraun) connected to a nerve stimulator (Pajunk Vario) was placed with real time ultrasound control within the middle scalene muscle next to the trunks of the plexus.