1 5 3
S E P T E M B E R 2 0 1 5 | O U T P AT 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
Resistance should be minimal during threading. Keep in mind that sig-
nificant resistance usually means the catheter is obstructed and coil-
ing, instead of threading.
9. As I remove the Touhy needle, I advance a few extra centimeters
of catheter slack to further prevent dislodgement with future leg
movement. Ultimately the catheter depth marking at the skin will be
between 10 to 15 centimeters.
10. I perform a test dose injection with 3 ml of 1.5% lidocaine with
1:200,000 epinephrine and use ultrasound visualization to confirm
proper extravascular catheter tip location in the adductor canal.
11. Lastly, I wipe the ultrasound gel off the leg, apply liquid adhesive
widely, apply skin sealant to the insertion site to reduce leakage, coil
the catheter around the insertion site, apply several steri-strips, and
apply a large clear plastic dressing to ensure that the lower margin of
the dressing remains proximal to the eventual lower margin of the
tourniquet and avoids interfering with the surgeon's sterile field. OSM
Dr. Winchester (brandon@blockjocks.com) is the regional anesthesia fellowship director at Andrews
Institute for Orthopedics & Sports Medicine in Gulf Breeze, Fla., and the co-founder of blockjocks.com.
that requirement.
Searching for a definitive definition of emergence, a U.S. District Court found
none. That lack of clarity, it said, meant that AAKC's interpretation of the rule, while
"opportunistic," was nonetheless plausible. So it dismissed the case.
Interestingly, however, the court may have nudged open the possibility of another
complaint by acknowledging that the failure of anesthesiologists to be present dur-
ing extubation might have made a more compelling argument that they weren't
"personally (participating) in the most demanding aspects" of cases. But the former
employee raised that issue too late in the legal process for it to be considered in this
case. — Jim Burger
