The purpose of this study is to determine if a handheld ultrasound device helps in the placement of labor epidurals by studying the accuracy of the Accuro Handheld Ultrasound device compared to a standard ultrasound machine.
Pregnant women who present to Labor and Delivery for an anticipated vaginal delivery will be identified as potential participants based on inclusion/exclusion criteria and their desire for labor epidural analgesia. Ultrasound evaluations will be conducted in a cohort of 50 parturients who decide they want epidural analgesia in labor. Prior to epidural placement, a hand held ultrasound device will be utilized to identify L2/3, L3/4 and L4/5 interspace. A mark will be made on the patient's back at these levels. The handheld ultrasound device will also estimate the depth to epidural space at each level using its programmed algorithm. A standard ultrasound will then be used to locate the same interspaces, identify midline, and estimate depth to epidural space with caliper calculation. Upon patient request, an epidural will be placed at L3/4 with a loss of resistance to saline technique. The actual depth to loss of resistance during epidural insertion will be determined by measuring the Tuohy with a sterile measuring tape while it is in the skin.
Study Type
OBSERVATIONAL
Enrollment
50
Use of an Accuro Handheld Ultrasound to identify lumbar interspaces, midline, and depth to epidural space
Use of standard ultrasound as gold standard to identify lumbar interspaces, midline, and depth to epidural space
Lucille Packard Children's Hospital
Palo Alto, California, United States
Depth to Epidural Space
Determine the difference between the Accuro ultrasound epidural space depth estimation and actual Tuohy epidural depth during epidural insertion at L3/4
Time frame: Within 24 Hours of enrollment
Midline Identification
The difference between the Accuro Handheld Ultrasound identification of midline and standard ultrasound machine identification of midline
Time frame: Within 24 Hours of enrollment
Interspace Identification
The difference between the Accuro Handheld Ultrasound identification of interspace level and standard ultrasound identification of interspace level
Time frame: Within 24 Hours of enrollment
Time to Epidural Placement
Specifically time from insertion of the Tuohy into the skin until removal of the Tuohy after epidural catheter threading
Time frame: Within 24 Hours of enrollment
Interspace Levels Attempts
Number of interspace levels attempts for epidural placement
Time frame: Within 24 Hours of enrollment
Epidural Failure Rate
Need for replacement epidural or change in anesthetic technique
Time frame: Within 24 Hours of enrollment
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