HEREFORD HOSPITALS NHS TRUST

Department of Anaesthesia & Critical Care

Obstetric Anaesthesia and Analgesia Guidelines
GUIDELINES FOR OBSTETRIC EPIDURAL BLOOD PATCH
To be considered if post-dural puncture headache (+/- associated symptoms) severe
at 24-48 hours post dural puncture and not improving (accidental dural puncture
with Tuohy needle or following deliberate spinal anaesthetic). Usually carried out
after 48 hours as reduced success rate if performed earlier. Early blood patch via
epidural catheter is not recommended as catheter tip position is unknown, success
rate is less and procedure may be unnecessary. We do not perform prophylactic
blood patching, as this may be an unnecessary procedure.
DO NOT perform if any possibility of local or systemic infection because of risk of
epidural abscess or meningitis.
Check temperature and white blood cell count a short time before proposed blood
patch.

Decision to perform made only by consultant anaesthetist after full

consideration of circumstances.
Full explanation of options to patient including purpose and side
effects/complications, e.g. backache, failure, further dural puncture and
epidural abscess
Written consent from patient
Blood patch performed in room on delivery suite
Requires two doctors
anaesthetist performing blood patch
2nd doctor to perform venepuncture
Full aseptic conditions for epidural insertion and iv cannula insertion/drawing
of blood is vital. Both doctors wearing gown, gloves, mask, hat
Insertion of intravenous cannula in large arm vein for drawing of blood
Lumbar epidural performed at convenient space
The second doctor then draws 30ml blood through the IV cannula (or by direct
venepuncture)
Anaesthetist slowly injects approximately 10-20ml blood through Tuohy
needle, retaining 10ml for blood culture (5ml for each of a pair of blood culture
bottles)
Stop epidural injection of blood if mother experiences back or leg pain
Place dressing over epidural site
Patient to lie flat
Send blood culture bottles to Microbiology laboratory
Patient is allowed to get up after two hours
May go home next day if asymptomatic after anaesthetic review and
discussion with consultant anaesthetist, and advised not to lift heavy objects
for one week.

Contact patient next day at home, the following day and at one week to check
no recurrence of PDPH symptoms or back/leg/sphincter problems. Record
consultations in notes.
Mother must be instructed to contact Maternity Unit/Obstetric anaesthetist
immediately if any related problems
Follow-up blood culture results to check no growth. If positive culture, results
should be treated with caution and immediate Microbiology consultant advice
should be sought. Ask patient to return to hospital immediately for
consultation and appropriate treatment.

Note: History of previous epidural blood patch is not a contra-indication to

subsequent epidural or spinal block.
Microbiological aspects of these Guidelines agreed with Dr. S. Edmondson,
Consultant Microbiologist, Hereford Hospitals NHS Trust.

References:Guidelines for Obstetric Anaesthetic Trainees, Cardiff and Vale NHS

Trust.
Birmingham Womens Hospital Guidelines for Obstetric Anaesthesia
2005.
Obstetric Anaesthesia Guidelines, King Edward Memorial Hospital, Perth,
Western Australia 2005.
Sharpe P. Accidental Dural Puncture in Obstetrics. BJA CEPD News
2001;Vol1, No.3, 81-84.

Dr. Nigel Salmon : 05.04.06

Review Date:
April 2008