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Topic: Tuohy needle

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	Tuohy needle - Ganfyd
		The Tuohy needle is used in the technique of loss of resistance to injection to gain safe access to the epidural space, typically to produce epidural anaesthesia.
		The bluntness adds to the force required to advance the needle through the tough ligaments of the spine, but this contributes to its safety, as the "feel" of the needle is improved, and it is less likely to puncture the dura accidentally.
		Because of its large gauge and blunt tip, the Tuohy needle may also be used for other applications, such as the insertion of a catheter for a paravertebral block, or single-shot aspiration of pleural effusion fluid.
	www.ganfyd.org /index.php?title=Tuohy_needle (0 words)

	B. Braun - Perifix® Safety Epidural Needles
		The Perifix Safety Epidural Needle uses B. Braun's proven safety clip technology to reduce the needlestick risk for the epidural needle with virtually no change in your technique.
		The safety clip is positioned within the yellow plastic housing near the hub of the needle.
		When it is convenient for you to activate the safety clip, you advance the plastic housing to the tip of the needle until the safety clip engages.
	www.bbraunusa.com /perifix/safety.html (0 words)

	Hypodermic needle help - Wiki at Help.com (Site not responding. Last check: )
		A hypodermic needle is used for instant delivery of a drug, or when the injected substance cannot be ingested, either because it would not be absorbed (as with insulin), or because it would harm the liver (as with testosterone).
		The diameter of the needle is indicated by the needle gauge.
		Disposable needles are embedded in a plastic or aluminium hub that attaches to the syringe barrel by means of a press-fit (Luer) or twist-on (Luer-lock) fitting.
	www.help.com /wiki/Hypodermic_needle (449 words)

	Hypodermic needle
		A hypodermic needle is used when the substance would not be reliably absorbed by the digestive system, as is the case with insulin and many other drugs or if the substance needs to be instantly delivered into the body.
		The diameter of the needle is indicated by the needle gauge.
		Needles in common medical use range from 7 gauge (the largest) to 33 (the smallest) on the Stubs scale.
	www.mrsci.com /Medical-Equipment/Hypodermic_needle.php (364 words)

	Epimed: Catheter Introducers
		Packaged with a 17g Tuohy needle for use as an obturator.
		A significantly safer alternative to standard epidural needles, the R.K. is ideal for introducing catheters 19g or smaller.
		As with the Epimed R.K. Epidural Needle, the RX rear heel is rounded to resist catheter shearing during placement.
	www.epimedint.com /prodcats.php?id=4 (360 words)

	Epidural needle location indicator assembly - Patent 5205828 (Site not responding. Last check: )
		Tuohy needles are prepared by the manufacturer by inserting a stilette into the needle so that the stilette is flush with or extends somewhat beyond the anterior end of the needle.
		The present invention is of a needle assembly, typically an epidural needle assembly, which can aid in guiding the anesthetist in bringing the needle tip to its proper location in the epidural space semi-automatically with reduced reliance on the feel of the needle in the hand of the anesthetist.
		Needle 10 is attached to a housing or case, typically a syringe 14 through a hub 16.
	www.freepatentsonline.com /5205828.html (5092 words)

	Needle - Wikipedia, the free encyclopedia
		Needles, California, a city in the Mojave Desert
		Needles (Black Hills), granite pillars located in South Dakota
		Needle gun, a Prussian weapon with a needle-like firing pin
	en.wikipedia.org /wiki/Needle (174 words)

	Catheter system for administration of continuous peripheral nerve anesthetic - Patent 5976110 (Site not responding. Last check: )
		A catheter system having an epidural needle, an electrically conductive stimulation wire attached to the needle, a multi-purpose connector, which is adapted to connect to intravenous tubing for supplying local anesthesia, and an epidural catheter for supplying regional anesthesia.
		The epidural needle has a distal end and a proximal end, with the distal end terminating in a beveled aperture and having a sharp tip adapted for insertion into a nerve sheath (alongside a nerve plexus) of a patient, and with the proximal end being adapted for connection, such as to the below-described multi-purpose connector.
		Withdraw the stylet from the insulated TUOHY needle and attach the adapter assembly by rotating its spin-lock collar clockwise onto the needle hub.
	www.freepatentsonline.com /5976110.html (3453 words)

	Epidural Technique (Site not responding. Last check: )
		When the needle is in the ligamentum flavum, increased resistance is transmitted to the plunger, only to disappear when the epidural space has been entered (Chapter 32).
		The needle is partially withdrawn and redirected cephalad and towards the midline until the previous depth is attained.
		The Tuohy needle is gently removed and the catheter is fixed to the skin under a transparent adhesive dressing.
	www.manbit.com /oa/c1.htm (496 words)

	[No title]
		An improved needle set for the needle-through-needle technique would be one with a modified Tuohy needle having an aperture at the back and a spinal needle protruding more than 13 mm beyond the Tuohy needle.
		Needle trauma and local anesthetic neurotoxicity are the most common causes of neurologic complications related to neuraxial anesthesia.
		The needle used in our case was the same as those of the seven patients previously reported was a pencil point of 27-G, and similarly, this patient complained of pain and paresthesia and also experienced symptoms when the spinal block regressed.
	www.ispub.com /ostia/index.php?xmlPrinter=true&xmlFilePath=journals/ija/vol8n1/foot.xml (2531 words)

	A new peridural needle-the 'LOLO' needle. Delima LK, Delima DF - J Postgrad Med
		Recognising the fact that to produce a needle that is both sharp on the spinal ligaments and blunt on the dura, is impossible with a needle with a circular cross section, the 'LOLO' peridural needle was made to have a square cross section.
		With the Tuohy's needle although localisation of the peridural space was not difficult, there was very little dural tenting possible and attempts to create the same tenting effect as seen with the 'LOLO' needle resulted in a perforation and was indicated by an extradural leak in the contrast medium [Figure - 5].
		In conventional needles all the force of insertion is concentrated at the needle point resulting in a greater force per unit area with an eventual perforation as seen in the myelographic study.
	www.jpgmonline.com /article.asp?issn=0022-3859;year=1989;volume=35;issue=2;spage=74;epage=8;aulast=Delima (2142 words)

	Longer Needle More Effective at Obtaining CSF for Combined Spinal Epidural Analgesia
		In a recent study, the Sprotte needle was associated with a significantly higher failure rate (17%) for obtaining cerebrospinal fluid (CSF) during combined spinal epidural analgesia for labor and delivery; this finding comes from a comparison with the longer Gertie Marx needle, which had a 100% success rate in obtaining CSF.
		The Sprotte needle is 9 mm in length beyond the top of the Tuohy needle with the hubs engaged; the Gertie Marx needle extends 17 mm beyond the tip of the Tuohy needle.
		The procedure was performed with either of the two needles using a midline approach at L2-3 or L3-4 with the patient sitting.
	www.imd-inc.com /w_longerneedle.html (610 words)

	[No title]
		Using a 22-gauge, 3.5 inch tuohy epidural needle attached via extension tubing to a syringe, the shaft of the needle is grasped by the dominant hand of the operator.
		The needle is inserted through the skin wheal and advanced anteriorly in the parasagital plane (perpendicular to the back in all directions) until it contacts the transverse process, 2-5 cm, depending on the body habitus of the patient (see figure 4).
		As a safety measure, to prevent inadvertent deep placement, we grasp the needle at a point from its tip that is equal to the estimated depth from the skin to the transverse process.
	www.ispub.com /ostia/index.php?xmlPrinter=true&xmlFilePath=journals/ija/vol3n1/block.xml (1856 words)

	Tuohy needle - Wikipedia, the free encyclopedia
		A Tuohy needle is a hollow needle, very slightly curved at the end, suitable for inserting epidural catheters.
		A 16G Portex Tuohy needle and epidural catheter.
		This page was last modified 17:42, 21 July 2006.
	en.wikipedia.org /wiki/Tuohy_needle (58 words)

	[No title]
		The stylet is withdrawn, the syringe is attached gently to the needle, and local anesthetic is deposited slowly as the needle is withdrawn ensuring a generous bleb of anesthetic is deposited under the skin.
		It is vital to ensure that the needle is parallel to the floor/table and is being advanced perpendicularly to the patient's spine exactly on the patient's midline and that the open bevel of the needle tip is facing cranially.
		The stylet of the Tuohy needle is then removed and carefully wiped on a sterile portion of the gloved hand to ensure no cerebrospinal fluid is visible.
	www.milaint.com /EpiInstr.php (1744 words)

	Technique
		However, care must be taken to ensure that the antiseptic solution does not contaminate the epidural needle or other material to be introduced into the epidural space.
		Should difficulty be experienced in advancing the catheter then rotation of the epidural needle may be tried.
		The Tuohy needle should not be rotated while the catheter is in the needle.
	www.westmeadanaesthesia.org /policies/obstetrc/epipolcy/ppepi02.htm (593 words)

	Regional Anesthesia Education Initiatives
		But if the catheter is still stuck to the needle, the needle and catheter should be removed as a unit and the needle recited.
		On the other hand, the Tuohy needle was primarily designed to avoid penetrating the dura during epidural block.
		Good stimulation of femoral nerve with the needle (lost at 0.3mA) but was unable to feed the catheter despite several manipulations of the needle.
	www.raeducation.com /about/two.htm (1399 words)

	Epidural Anaesthesia (page 2)
		While the tip of the needle is in the interspinous ligament there may be some loss of saline into the tissues as the tissue is not particularly dense, but there is usually significant resistance to pressure on the plunger.
		The markings on the needle will show the depth of the needle from the skin to the epidural space, and this distance will help determine the depth to which the catheter should be inserted at the skin.
		Advance the needle; perpendicular to the skin until the lamina or pedicle is encountered, and then redirect it approx 30° cephalad and 15° medially in an attempt to "walk the needle" off the lamina, at which point the needle should be in close proximity to the ligamentum flavum.
	www.nda.ox.ac.uk /wfsa/html/u13/u1311_02.htm (2008 words)

	New York School Of Regional Anesthesia - Continuous Lumbar Plexus Block
		The needle is attached to the nerve stimulator (1.5 mA, 2 Hz, 100 µsec) and to a syringe with local anesthetic.
		A 10-cm, Tuohystyle tip, continuous block needle is inserted at a perpendicular angle and advanced until the quadriceps twitch response is obtained at 0.5 to 1.0 mA current.
		Failure to obtain a quadriceps muscle twitch on the first needle insertion is common, even with proper needle placement, simply because the needle tip may pass between the two roots and thus stimulation is not obtained.
	www.nysora.com /techniques/continuous_lumbar_plexus_block (1544 words)

	11rc3
		When the Tuohy needle tip has reached the epidural space, it is of utmost importance not to advance it further, thereby risking puncture of the dura mater.
		The hanging-drop sign (when a drop of saline is placed in the hub of the needle and is sucked into the hub when the needle tip penetrates the ligamentum flavum) cannot be recommended for the lumbar epidural block.
		The epidural catheter (or CSE spinal needle) should be inserted carefully through the Tuohy needle, bearing in mind that the dura is directly in front of the catheter or needle tip and is the only structure causing resistance to advancement of catheter or needle.
	www.euroanesthesia.org /education/rc_nice/11rc3.html (1643 words)

	Epidural needle deviation is greater in tougher simulated tissues (Site not responding. Last check: )
		The forces applied to the needle tip during advancement of the needle cause the needle path to veer off (deviate from) a straight line (Kopacz 1995.) We were interested to see to what extent the consistency (resistance) of the simulated tissue would influence the degree of deviation.
		The force required to insert the epidural needles varied from 2 to 20 Newtons with higher concentrations of gelatin requiring greater forces.
		Figure 1: The epidural needle was inserted at right angles into the core of the gelatin tube and advanced until the needle tip was seen to exit from the side of the tube.
	www.anestech.org /media/Publications/Annual_2003/sta114.html (328 words)

	NeuralBlock.com UltrasoundBlock.com
		Generally, the fatter and blunter the needle tip the less likely it is to penetrate a nerve and therefore more likely it is to simply push it away.
		In terms of the possibility of an intraneural injection, the needle with the highest risk would be a 25g hypodermic needle with a penetrating tip.
		Likewise in order of decreasing risk would be a 22g stimuplex needle, 22g short bevel plexufix needle and lastly an 18g tuohy needle such as the contiplex tuohy.
	homepage.mac.com /michaelfredrickson/neuralblock/page13/page13.html (735 words)

	No Risk of Metal Toxicity in Combined Spinal-Epidural Anesthesia -- Holst et al. 88 (2): 393 -- Anesthesia & Analgesia
		of the Tuohy needle with a 27- or 29-gauge Quincke spinal needle.
		The bevel of the Quincke needle was rotated 90° in relation
		was opposite to the bevel of the Tuohy needle and inserted roughly.
	www.anesthesia-analgesia.org /cgi/content/full/88/2/393 (2092 words)

	A Comparison of Espocan(R) and Tuohy Needles for the Combined Spinal-Epidural Technique for Labor Analgesia -- Browne ...
		18-gauge Tuohy needle with 27-gauge Gertie Marx atraumatic spinal
		the spinal needle, a multi-orifice polyamide 20-gauge epidural
		of paresthesia on insertion of the spinal needle, unintentional
	www.anesthesia-analgesia.org /cgi/content/full/101/2/535 (2852 words)

	Design Technology - Medical / Scientific
		Anaesthetists confirm that maintaining control of both needles whilst the analgesic is injected is a difficult procedure, particularly as movement of the spinal needle could damage the delicate spinal cord.
		The challenge was to design a new spinal epidural injection system that maintained the delicate feel of the existing device yet allowed the spinal needle to be locked securely in place to prevent further movement once Dural puncture had been detected.
		With the spinal needle securely locked the anaesthetist would be free to inject the analgesic and concentrate on monitoring the patient.
	www.design-technology.co.uk /ex/medical/medical1.html (171 words)

	New York School Of Regional Anesthesia - Continuous Thoracic Paravertebral Block
		The needle is attached to a syringe with local anesthetic and advanced in a saggital and slightly cephalad plane to contact the transverse process.
		Once the transverse process is contacted, the needle is withdrawn back to the skin and reinserted with a 10º-15º cephalad angle to "walk off" 1 cm past the transverse process and enter the paravertebral space.
		If it is deemed that the needle is inserted too laterally (inability to advance due to the needle-rib contact), the needle should be reinserted medially rather than oriented medially (risk of spinal cord injury).
	www.nysora.com /techniques/continuous_thoracic_paravertebral_block (1660 words)

	ASSH \| Correspondence News
		Using a pair of needle holders, while keeping the plastic stylet in the needle, the Tuohy is grasped loosely near the hub by the semi open jaws of the needle holder.
		The broken off Tuohy needle is inserted in the Microaire wire driver centering it with the blue centering device from the prior.035” k-wire.
		The Tuohy is removed and the tension band wire is then tightened down as the mallet fragment is walked distally and rotated into the trough at the base of P-3.
	www.assh.org /AM/Taggedpage/KBCorrespondenceNews.cfm?ICID=2&Year=2002&Month=12 (4509 words)

	Epidural Injection (Site not responding. Last check: )
		The Tuohy needle is inserted into the interspinous ligament with the stylette in place.
		The needle is now advanced slowly through the interspinous ligament into the ligamentum flavum using either a continuous or intermittent movement.
		As the needle is advanced, pressure is applied to the plunger of the syringe.
	www.manbit.com /oa/fe-3.htm (195 words)

	Right to the Point - Hospital for Special Surgery - Anesthesiology Department - anesthesiology, anesthesia, ...
		A 17g Tuohy needle is advanced via a midline or paramedian approach through the ligamentum flavum until a loss of resistance to air is noted within the epidural space.
		A 27g pencil-point needle is then placed through the Tuohy needle, and a characteristic “pop” is felt as the spinal needle punctures the dura.
		A 17g Tuohy needle is advanced using the paramedian or midline approach until a loss of resistance to air is encountered in the epidural space.
	www.hssanes.org /for-professionals/featured-focus-of-interest.htm (4712 words)

	How much work is required to puncture dura with Tuohy needles? -- Lewis et al. 85 (2): 238 -- British Journal of ...
		Tuohy needle was advanced through the dura with the bevel oriented
		The machine advances the needle and is capable of measuring the total distance travelled and the peak force at the point of dural penetration.
		observed with the needle oriented parallel to the fibres.
	bja.oxfordjournals.org /cgi/content/full/85/2/238 (1768 words)

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