Nurse Anesthetists' Perceptions and Use of Ultrasound for Epidural and Spinal Needle Placement in Obese Parturients

Abstract

Purpose: The use of ultrasound scout scans and real-time ultrasound scanning for epidural/spinal needle placement is possible, but not prevalent in obstetric anesthesia practice. Ultrasound use in the obese parturient with impalpable landmarks can facilitate epidural/spinal needle placement. It is estimated that 50% of parturients are obese and eight percent of those are considered morbidly obese as defined by a BMI ≥ 40 kg/m2.6 A survey of Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs) was utilized to determine their knowledge of ultrasound for epidural/ spinal needle placement, the availability of ultrasound equipment, and barriers to ultrasound use in obstetric anesthesia practice. Previous studies have not included CRNAs. Methods: An online survey was distributed to 1,882 practicing CRNAs and SRNAs to determine their knowledge, access, and perceptions of ultrasound used for epidural and spinal needle placement in parturients with a BMI ≥ 35 kg/m2. Results: Of the109 respondents, 85% were involved in obstetric anesthesia services, and 76% were regularly involved in the care of parturients with a BMI ≥ 35 kg/m2. 57% of respondents had used ultrasound for a scout scan, and 29% used ultrasound in real-time needle placement. There was 100% agreement that ultrasound was helpful in needle placement when landmarks were indistinguishable. Barriers included a lack of knowledge, equipment, and privileges. Conclusion: Ultrasound for epidural and spinal needle placement is known by CRNAs and SRNAs and is considered useful for needle placement in a parturient with a BMI ≥ 35 kg/m2. The survey data showed that CRNAs who utilized ultrasound for epidural/spinal needle placement found it useful; however, they did not find it necessary in every case despite the parturients size. Because of the low response rate, further research is necessary. Data Sources: Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCOhost, Google Scholar, Medscape, PubMed.