I have just completed my first week of a 7 week OB rotation and I finished it off with a "wet tap" instead of an epidural. The patient was a 19 y/o who was 5'5" and 135 pounds. I had no trouble with the placement at L4-5; the catheter threaded great, the 3cc test dose was negative and I had negative aspiration of the catheter while sitting so I taped the catheter in place. BEFORE
dosing the catheter, we turned the patient supine and then she started saying her feet were getting numb and her BP dropped and she got "sleepy". Then when I aspirated the catheter I got fluid. We immediately did a blood patch, pulled the catheter and waited 1 1/2 hours before trying again. Although I was "gun shy" about it, I again did the epidural at L3-4 and had no trouble advancing the Touhy and got good LOR, negative aspiration and threaded the catheter easily and instantly got + aspiration in the catheter.
It took the MDA another 20 minutes to get a working epidural.
Needless to say I ended the week on a down note and am quite frustrated with the epidural. I know it takes practice and you pretty much have to just do them to learn how. Does anyone have any suggestions on learning how to place an epidural? How did you learn how to do them? My preceptor and MDA both said my technique was very good and they don't know what happened. On a good note, I did sucessfully place 3 others this week (how I don't know). Any advice or personal stories would be great!