Page 508 - WSAVA2018
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 25-28 September, 2018 | Singapore
makes the turn at the tip of the Tuohy needle on its way cranially. After this the catheter should advance smoothly with minimal resistance. If difficulty is encountered in attempting to advance the catheter past the tip of the needle, then withdraw the cathe- ter to ensure the tip is within the barrel of the Tuohy needle once again. Then gently put cranial pressure on the hub of the Tuohy needle and move it cranial- ly 5 to 25mm and attempt to advance the catheter once again. If resistance is encountered again, then the needle placement is likely incorrect. The cath- eter should be withdrawn, and needle placement rechecked. If a positive site for advancement of the catheter with minimal resistance is not found after 2-3 successive attempts then needle placement should take place with fluoroscopic guidance.
· Once the catheter advances with minimal resistance then the catheter should be advanced until the second mark on the catheter is entering the cathe- ter hub. Advance the catheter 10-25mm further and then gently withdraw the Tuohy needle, the catheter guidewire, and the catheter guide over the catheter and completely remove them from the catheter.
· The second mark on the catheter should now be vis- ible outside the patient. If the first mark is not visible then withdraw the catheter gently until the first mark is visible outside the patient.
· The catheter is then cut to allow 10 to 20cm of cathe- ter to remain outside the patient.
· The catheter tip is then gently inserted into the ta- pered end of the injection adapter until resistance is met, withdrawn 1-2mm and then the hub is tightened.
· The floating luer end of the 0.22 micron filter device is then attached firmly to the hub of the catheter adapter after removing the plastic coverings of both devices. The luer tip catheter injection port is then firmly attached to the other end of the 0.22 micron filter device after removing the plastic coverings of both devices.
· Catheter placement is then verified by attempting to inject a small quantity of preservative free 0.9% sterile saline through the filter device and into the catheter. Because of the small inside diameter of the catheter, the resistance to injection is large. As long as injectate continues to flow, then catheter placement is confirmed. Radiographic verification is recommended to confirm correct placement of the epidural catheter tip.
Carefully attach a clean tape butterfly to the catheter near the skin-catheter interface and suture or staple the tape butterfly to the patient. A second clean tape butterfly is attached to the filter device and stapled or sutured to the patient.
· The skin around the catheter-skin interface is wiped
1. Liotta A, Busoni V, Carrozzo M, Sandersen C, Gabriel A, Bolen G. Feasibility of Ultrasound-Guided Access at the Lumbo-Sacral Space in Dogs. Veterinary Radiology & Ultrasound. 2015;56(2):220-8.
2. Steagall PVM. An Update on Drugs Used for Lumbosacral Epidural Anesthesia and Analgesia in Dogs. Frontiers in Veterinary Science. 2017;4:68.
3. Torske KE, Dyson DH. Epidural analgesia and anesthesia. The Veterinary clinics of North America Small animal practice. 2000;30(4):859-74.
again with an antimicrobial skin preparation and a small amount of sterile antimicrobial ointment (beta- dine or chlorhexidine) is placed at the catheter-skin interface. An occlusive plastic skin drape is then placed over the entire area to secure the catheter and prevent accidental removal.

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