Table 1.
Procedural checklist for subarachnoid block.
| Task | Satisfactory | Unsatisfactory |
|---|---|---|
| (1) Performs a “time-out” and places monitors on patient (pulse oximetry and NIBP). | — | — |
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| (2) Verifies that spinal kit tray, nonsterile and sterile gloves (correct size), and cleansing solution are present. | — | — |
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| (3) Palpates the superior aspects of the iliac crests and identifies the intersection at the L4 spinous process with nonsterile gloves on. Marks position at the L3/L4 or L4/L5 interspace. | — | — |
|
| ||
| (4) Cleans the overlying skin with chlorhexidine. | — | — |
|
| ||
| (5) Opens the spinal tray before placing sterile gloves on. | — | — |
|
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| (6) Puts on sterile gloves with proper technique. | — | — |
|
| ||
| (7) Applies sterile drapes. | — | — |
|
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| (8) Draws up lidocaine in the 3cc syringe and bupivacaine in the 5cc syringe. Administers local anesthesia in a wheal at the previously marked site. | — | — |
|
| ||
| (9) Injects more anesthetic in the correct location and angle. | — | — |
|
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| (10) Inserts the introducer needle in the middle of the interspace with a slight cephalad angulation of 10 to 15 degrees. The bevel of the spinal needle should be in the sagittal plane. | — | — |
|
| ||
| (11) Advances spinal needle through anatomic structures until the subarachnoid space is reached. May experience a popping sensation as the ligamentum flavum is crossed. | — | — |
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| (12) Withdraws the stylet each time a pop is felt to assess for CSF flow. | — | — |
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| (13) Confirms CSF flow by aspiration before and after injecting anesthetic. | — | — |
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| (14) Removes the spinal and introducer needle together once completed. | — | — |
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| (15) Applies pressure with the provided 2 × 2 gauze and assesses good hemostasis. | — | — |
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| (16) Removes the drape, lays the patient, and observes vitals. Disposes of all sharps and biohazard material appropriately. |
— | — |