Pediatric Lumbar Epidural Catheter Placement

This was an epidural catheter placement on a 2-year-old male patient for a left hip osteotomy. His past medical history was remarkable for a congenital heart defect, bilateral congenital hip dislocations and a sacral dimple without any other neurologic anatomical abnormalities on the neonatal spine ultrasound. The patient was placed in a left lateral decubitus position. Using anatomical landmarks, the target epidural level was identified and marked. The patient’s back was prepped and draped under sterile conditions. An 18-gauge, 5 cm length Tuohy needle was used to encounter the epidural space. Subsequently a 20-gauge catheter was placed through the needle to a depth of 4.5 cm at the level of the skin. Negative aspiration of blood or CSF was confirmed. A 1 mL test dose of lidocaine 1.5% with epinephrine 1:200,000 was given without any cardiovascular changes on the monitors. Finally, the catheter was secured to the back of the patient. Parental consent was obtained for the publication of this video.

How to Correctly Place the Pelvic Binder – A Life-Saving Technique

This video demonstrates how to place the pelvic binder quickly and correctly, which may be life-saving in cases of pelvic ring fractures with associated potential massive bleeding. Proper pelvic binder placement technique requires attention to some details, including the 5Ps (pulses, penis, pockets, pain and pulses), horizontal force application in opposing vectors and ensuring the pelvic binder is locked.

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