Blood patch

A blood patch is used when a pt. has a small leak after a lumbar puncture that causes a "spinal headache." An 18g angio is inserted in the arm, and then the doc withdraws a small amount of blood then injects it back into the location there the LP was done. This helps to seal over the leak, and usually pts. have significant improvement in symptoms in about an hour.

Anesthesia usually does the blood patches at our hosp., occ they're done by the neuro. doc.

Spinal headaches can be brutal, and usually you can tell it's a spinal h/a because when the pt. lies flat the h/a gets beter, but as soon as the pt tries to sit up the pain becomes severe.

In your clinical situation, the pts. are developing the leaks post-epidural, not from diagnostic LPs.

The way that I understand it is sometimes after epidural there is a slow leak of spinal fluid into the epidural space from a potential microtear in the dura. This slow leak causes a decrease in CSF pressure and volume leading to related symptoms, but mainly severe headache because the CNS structures are very pain sensitive. It is thought that by drawing some of the pt's own blood and introducing it into the epidural space, it forms a clot, sealing up that microtear and stopping the leak. Hope that helps. SG

:yeahthat: :yeahthat: :yeahthat:

We try things like lots of fluids (PO and IV), traditional pain meds both narcotic and non-narcotic, caffeine and having them lay as flat as possible for as long as they can stand it. Pts usually do better, but occasionally they will need a blood patch. It is a repeat of the epidural procedure, but instead of injecting pain meds they inject the patient's own blood - and it forms a patch/scab over the tear in the dura.

Have only seen it happen a couple of times in the five years I've worked in OB. Granted, it is a small unit, but still - not very common.

Just FYI to the OP, we see them outside of OB also. For CSF leaks after epidural for any surgery, a lumbar puncture, or a surgery that opens the spinal coloum like a Laminectomy. If any of these results in a CSF leak a blood patch may be an option.

~Jen