Epidurals/Tatoos

  1. There is a thread going on on the OB forum right now concerning the safety of administering epidurals through a tatoo. Apparently some anesthesia providers won't do them if it is necessary to go through an inked area.
    I was wondering what you all know about this and what your experience has been.
    Thanks!
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  2. 15 Comments

  3. by   MikeyJ
    My brother is a tattoo artist and he tells his female clients that same thing, but I know of family and friends who had lower back tattoo's who were able to get epidurals. I have always wondered the same thing though...
  4. by   deepz
  5. by   PRESLA
    ]Were I have worked depends on MD younger ones will place an epidural where a tat is but the older ones won't go near them. I also worked 3rd and the older MD's got pissed if called in the middle of the night for an epidural so they would us anything for an excuse not to place one. :trout:

    Lisa


  6. by   Summitk2
    Quote from PRESLA
    ]...depends on MD...
    Yes, and it probably depends on the NURSE ANESTHETIST too. Did you notice what forum you're posting in?
  7. by   PRESLA
    ]CRNA's at the hospital I had worked at would have had a DUCK if they had to place an epidural in a labor pt. They got pissed off if they had to get up out of bed for a c-section during the night.

    Lisa
  8. by   crnabrian
    Certainly the patient can have an epidural or spinal, as long as it is not a fresh tattoo. Barring other contraindications, of course.
  9. by   JoeCRNA
    As a matter of practice, I do not place epidurals through tattoo ink.
    The verdict remains out and although the risk is probably small, why take a chance...especially with an elective procedure.

    However, there is typically an interspace that is not inked or there is clear skin close enough to an interspace that it can be stretched over the interspace and the needle and catheter subsequently placed through clear skin.

    I have placed many catheters right between the antennae of a butterfly or through the centers of many a letter.
  10. by   MIM_RN
    When I was in labor with my first child, my anesthesia provider refused to administer an epidural because I had a tattoo in this region. He finally did so, after lots of discussion. (I honestly think he was ticked off because he had to wake up from his nap to administer it.) When having my second child, a different provider did not hesitate to administer it.
  11. by   CRNA2007
    What I was taught was if the tattoo was older than 6 months it was fine, but I was also told that they have new acrylic dyes for tattoos, and that you are not suppose to give an epidural or spinal through them.
  12. by   JoeCRNA
    Quote from CRNA2007
    What I was taught was if the tattoo was older than 6 months it was fine, but I was also told that they have new acrylic dyes for tattoos, and that you are not suppose to give an epidural or spinal through them.

    Some advice for a new CRNA, being a licensed advanced practitioner "I was taught..." is not a good enough rationale for anything. The standard of care, the evidence shows, etc. are rationales. We are not minions to our teachers (whether they be MDA, CRNA, or whoever), we are well trained, independently licensed, well read, mindful professionals, who act on behalf of our patients best interests.
  13. by   rph3664
    Quote from Summitk2
    Yes, and it probably depends on the NURSE ANESTHETIST too. Did you notice what forum you're posting in?
    I live in an area with a lot of D.O.s Don't forget them either.
  14. by   zrmorgan
    The Canadians...
    Can J Anaesth. 2002 Dec;49(10):1057-60
    "Based on the limited information available it is possible that inserting an epidural or spinal needle through a tattoo could cause long-term problems such as arachnoiditis or a neuropathy secondary to an inflammatory reaction, but we don't know. Until recently neither of the authors had seen a tattoo over the lumbar spine and this report is to draw attention to others regarding possible risks attending neuraxial anesthesia with these women."

    The French...
    1: Ann Fr Anesth Reanim. 2006 Jan;25(1):71-3. Epub 2005 Dec 28
    "To avoid this theoretical risk, the anesthesiologist should try to avoid puncturing through the tattoo, either by selecting a different vertebral interspace, or by using a paramedian approach or by finding a pigment free skin spot within the area of the tattoo. When these options cannot be implemented, a superficial skin incision prior to needle insertion should prevent from coring tattoo pigment when entering the skin. Whatever the final choice, the technique to be implemented should be determined as early as the antenatal visit, after informed consent."

    Interesting case presented in an Editorial...

    Labour analgesia in a parturient with lumbar tattoo: a routine management? or not?
    Krzysztof M. Kuczkowski, MD
    San Diego, California

    To the Editor:

    Douglas and Swenerton first reported on the administration of labour analgesia in three parturients with lumbar tattoos and discussed the possible ramifications of neuraxial analgesia in women with tattoos in the lumbar area.1 All three women received uneventful epidural analgesia, and no anesthesia-related complications were reported. I herein present a similar case, and the first report of a minor anesthesia complication resulting from epidural needle insertion through tattoos during the performance of neuraxial block. A 34-yr-old, healthy female at term was in labour and requested labour analgesia. Preanesthetic back examination revealed the colourful tattoos covering her entire lumbar area. An epidural block was performed in a standard manner (one attempt at L2-3 interspace) with an 18-gauge Tuohy needle. Several hours after an uneventful delivery, the patient reported tenderness and burning in the lumbar area where the epidural catheter had been sited. Examination revealed a localized L2-3 interspace tenderness, however, due to the presence of a tattoo in this area, skin redness (irritation) could not be determined. The neurological examination was normal and her symptoms resolved over the next 24 hr. A pigment-containing tissue core from a tattoo seems a possible cause of deeper lumbar tissue irritation.


    I guess the whole problem would be "coring" or ectopic pigment in the wrong place...don't know if I would go as far as to make an incision before placing the Thouy, but I might have a lengthy discussion with the Parturient about the possibilities of above...

    tough call...good luck

    Z

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