What is the recommended procedure when you have to withdraw and redirect the Tuohy needle during epidural placement?
If withdrawal and redirection of the Tuohy needle are required, it is possible that some of the saline will be expelled into the fatty/connective tissue during this process. This is because the unique design of the Episure AutoDetect maintains constant tension on the plunger; thus, fluid can be expelled if the needle passes through soft, fatty tissue. If this is noted to occur and it is interfering with placement of the epidural, two maneuvers can be used. First, some practitioners have described holding the plunger in the retracted position during redirection of the Tuohy needle. Second, some practitioners detach the Episure AutoDetect from the Tuohy needle during withdrawal/redirection, and then re-attach it after the Tuohy needle has been placed into the ligament.