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R E G I O N A L
A N E S T H E S I A
probes in a sterile sleeve. Use sufficient gel and try to make a smooth,
bubble-free interface between the sleeve and the probe so as not to
diminish visualization. We suggest a tissue adhesive (Dermabond, for
example) where the catheter exits the skin; it acts as a barrier against
infection and leaks, and helps prevent catheter migration. Make sure
you remove all blood, local anesthetic and ultrasound gel, and consider Mastisol Liquid Adhesive to ensure that the dressing stays firmly in
place. We use a statlock device to hold the catheter in place, and then
apply sterile Tegaderm transparent dressings. Remember to secure
catheters away from the surgical or tourniquet field, or uncomfortable
places for the patient. With proper attention and routine, leaks, infections and accidental pulls should be minimal.
7. See your patient in PACU
Visit patients in the PACU to assess catheter function and overall
patient satisfaction, and to reiterate instructions. If a catheter is not
working, troubleshoot and remedy the problem — by replacing the
catheter, performing a rescue single shot, or simply removing the
catheter and using other modes of analgesia. If the nerve block impedes
normal motor activity (a femoral catheter, for example), make sure a
sling or knee immobilizer is in place. Give the patient written instructions on block, infusion device and safety issues, and ensure he can
contact someone at all times for concerns. Finish by reviewing other
prescribed pain medications and how they should be taken. The goal is
clear communication, patient safety and patient satisfaction.
8. Keep good documentation to help troubleshoot
In the busy environment that most anesthesia providers work in, we
can do multiple procedures back to back without much of a break.
When you place a CPNB, however, you must absolutely track these
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | O C T O B E R 2013
