Epidural Steroid Injection
1/11/2022(Transforaminal ESI’s cannot be performed without a C-arm)
PREP: Refer to Lab Work Procedure Page to determine which drugs need to be discontinued and for how long. Pt. needs a driver.
Make sure patient has recent previous imaging of area of interest.
Dress patient in gown. Shirt, bra and pants off, gown open in back. Ask history questions and contrast questionnaire. Get patient to sign consent form. Check order for steroid amount and spine levels.
Patient is to be positioned prone on the table. Pillow under patient’s belly. Sheet to be tucked in patient’s underwear. Try to make patient as comfortable as possible. PLACE LEAD MARKER
Tray: Myelogram tray and add 25 gauge 1 ½ “needle, two 10ml syringe, and 18 gauge 1 ½ “ needle to tray. Discard 20ml syringe.
For Sabourin: Add Tuohy Needle
For Dr’s. Sud, Verville, Talley and Johnston: Use Epidural Tray Ref#: 555077 or 141992, or product code CESK-SD. Add same as above, plus long connecting tubing and band-aid. Use green syringe for contrast mixture for Dr. Sud and Dr. Talley.
Dr. Sud: Have 20ga x 3.5 Tuohy available. For Cervical ESI (only to be performed w/Dr. Sud), Pt prone, side of entry away from wall. He usually stands behind the C-arm. Pt to lie flat for 30 minutes.
10ml syringe: 9ml lidocaine & 1ml sodium bicarbonate
10ml syringe:10ml Omni 300. Be accurate w/contrast intra-thecal use only.
For Cervical Transforaminal, use CT, otherwise Fluoro.
Use a Tuohy needle for any Translaminar injection.
Use Spinal needle (15cm Lumbar, 10cm Cervical) for any Transforaminal Injection
Extra 10ml syringe and 18 ga needle is for the Radiologist to draw up Depo Medrol (for joint), or Dexamethasone [Solumedrol for Sud] (for spine) and Marcaine. Typically, the Radiologist injects 40mg [4mg for Sud] per ml for a total of 200mg of Depo Medrol and 3-4ml [1ml for Sud] Marcaine 0.25% (bupivacaine). Ask Radiologist what amount of steroid they want, even if it is specified on doctor’s order. Let Radiologist mark patient. See shoulder arthrogram protocol for Radiologist marking and glove preference. Patient may walk to recovery room, ask Radiologist how long to recover patient. Give patient Epidural discharge sheet.
Have 20ga x 3.5 Tuohy Needle ready in case Dr. needs one.