Steps 1-7

These three tabs outline the sequence of steps needed to perform a spinal anaesthetic.

These three tabs outline the sequence of steps needed to perform a spinal anaesthetic.

Step 1	Place a large bore IV line in the patient’s vein and connect fluids
Step 2

These three tabs outline the sequence of steps needed to perform a spinal anaesthetic.

Step 1	Place a large bore IV line in the patient’s vein and connect fluids
Step 2	Position the patient (lateral or sitting)
Step 3

These three tabs outline the sequence of steps needed to perform a spinal anaesthetic.

Step 1	Place a large bore IV line in the patient’s vein and connect fluids
Step 2	Position the patient (lateral or sitting)
Step 3	Identify and mark relevant lumbar interspace (L3/4 or L4/5) and the midline
Step 4

These three tabs outline the sequence of steps needed to perform a spinal anaesthetic.

Step 1	Place a large bore IV line in the patient’s vein and connect fluids
Step 2	Position the patient (lateral or sitting)
Step 3	Identify and mark relevant lumbar interspace (L3/4 or L4/5) and the midline
Step 4	Put on theatre hat and mask, scrub up and put on sterile gown and gloves
Step 5

These three tabs outline the sequence of steps needed to perform a spinal anaesthetic.

Step 1	Place a large bore IV line in the patient’s vein and connect fluids
Step 2	Position the patient (lateral or sitting)
Step 3	Identify and mark relevant lumbar interspace (L3/4 or L4/5) and the midline
Step 4	Put on theatre hat and mask, scrub up and put on sterile gown and gloves
Step 5	Prepare the skin with an alcohol or iodine based skin preparation
Step 6

These three tabs outline the sequence of steps needed to perform a spinal anaesthetic.

Step 1	Place a large bore IV line in the patient’s vein and connect fluids
Step 2	Position the patient (lateral or sitting)
Step 3	Identify and mark relevant lumbar interspace (L3/4 or L4/5) and the midline
Step 4	Put on theatre hat and mask, scrub up and put on sterile gown and gloves
Step 5	Prepare the skin with an alcohol or iodine based skin preparation
Step 6	Draw up intrathecal drugs using a filter needle
Step 7

These three tabs outline the sequence of steps needed to perform a spinal anaesthetic.

Step 1	Place a large bore IV line in the patient’s vein and connect fluids
Step 2	Position the patient (lateral or sitting)
Step 3	Identify and mark relevant lumbar interspace (L3/4 or L4/5) and the midline
Step 4	Put on theatre hat and mask, scrub up and put on sterile gown and gloves
Step 5	Prepare the skin with an alcohol or iodine based skin preparation
Step 6	Draw up intrathecal drugs using a filter needle
Step 7	Infiltrate the skin with 2-5 ml lidocaine 1% using a 25 g needle at the midpoint of the interspace

Select the Steps 8-11 tab to continue.

Steps 8-11

Step 8	Insert the introducer of the spinal needle until it is firmly gripped in the interspinous ligament
Step 9

Step 8	Insert the introducer of the spinal needle until it is firmly gripped in the interspinous ligament
Step 9	With the aperture directed cephalad (facing towards the patients’s head) carefully insert the spinal needle identifying the anatomical layers by “feel” during insertion
Step 10

Step 8	Insert the introducer of the spinal needle until it is firmly gripped in the interspinous ligament
Step 9	With the aperture directed cephalad (facing towards the patients’s head) carefully insert the spinal needle identifying the anatomical layers by “feel” during insertion
Step 10	If bone is encountered before the ligamentum flavum, remove the needle and withdraw the introducer almost to the skin then redirect either upwards or downwards before inserting the spinal needle
Step 11

Step 8	Insert the introducer of the spinal needle until it is firmly gripped in the interspinous ligament
Step 9	With the aperture directed cephalad (facing towards the patients’s head) carefully insert the spinal needle identifying the anatomical layers by “feel” during insertion
Step 10	If bone is encountered before the ligamentum flavum, remove the needle and withdraw the introducer almost to the skin then redirect either upwards or downwards before inserting the spinal needle
Step 11	When the ligamentum flavum is felt, push the needle forwards a couple more millimeters until a gentle pop is felt

Select the Steps 12-15 tab to continue.

Step 12	Remove the stylet of the spinal needle - appearance of CSF in the hub of the needle confirms correct placement
Step 13

Step 12	Remove the stylet of the spinal needle - appearance of CSF in the hub of the needle confirms correct placement
Step 13	Stabilize the needle with the back of the hand holding the needle braced against the mother’s back
Step 14

Step 12	Remove the stylet of the spinal needle - appearance of CSF in the hub of the needle confirms correct placement
Step 13	Stabilize the needle with the back of the hand holding the needle braced against the mother’s back
Step 14	Confirm CSF by gently aspirating on the syringe just before injection
Step 15

Step 12	Remove the stylet of the spinal needle - appearance of CSF in the hub of the needle confirms correct placement
Step 13	Stabilize the needle with the back of the hand holding the needle braced against the mother’s back
Step 14	Confirm CSF by gently aspirating on the syringe just before injection
Step 15	Remove syringe, needle and introducer as one at the end of the injection

Fig 1 illustrates the correct needle placement for spinal anaesthesia.

Step 12	Remove the stylet of the spinal needle - appearance of CSF in the hub of the needle confirms correct placement
Step 13	Stabilize the needle with the back of the hand holding the needle braced against the mother’s back
Step 14	Confirm CSF by gently aspirating on the syringe just before injection
Step 15	Remove syringe, needle and introducer as one at the end of the injection

Fig 1 illustrates the correct needle placement for spinal anaesthesia.

Fig 1 Correct needle placement