A discussion of the steps I take in every neuraxial block to minimize the chance of difficulty or failure. These steps will work for lumbar puncture or lumbar drain insertion as well.
0:29 Reasons for technical difficulty
1:38 Why it can be difficult to find the true midline
2:39 The importance of being meticulous and precise
3:50 The importance of controlling skin movement with 2 fingers
4:50 Video: Palpating with 2 fingers
5:30 Finding the true neuraxial midline
7:26 Video: Locating the midline with the finder needle
8:16 Accurate needle insertion and redirection
10:44 Video: Insertion of introducer and spinal needle
12:40 Dealing with sluggish CSF backflow or inability to aspirate