Thread: Blood Patch

A "blood patch" is used specifically for the treatment of spinal headache which can be an adverse effect of spinal anesthesia or very rarely epidural analgesia. Blood is removed from the patient's vein then injected into the spinal column therby "patching" leakage of spinal fluid which is causing the headache. the procedure devised using tubing connecting the vein to the spinal needle in a closed circuit was published in Jan Graziani's newsletter many years ago. It was an innovative approach at the time however the general feeling today, since we are more enlightened about matters of conscience, is that since the body is not feeding on the blood and it's entering the spinal column not the circulatory system it's a "matter of conscience." It is also a very effective way to treat spinal headaches that can be debilitating.

For a Jehovah's Witness patient who might refuse the blood patch due to the separation from the body, Dr. Saavedra's method might make it acceptable - same concept as closed circuit cell saver. Jan, do you or does anyone else have a reference for Dr. Saavedra's procedure that could be shared with our anesthesiologists?
Thanks.

A "blood patch" is used specifically for the treatment of spinal headache which can be an adverse effect of spinal anesthesia or very rarely epidural analgesia. Blood is removed from the patient's vein then injected into the spinal column therby "patching" leakage of spinal fluid which is causing the headache. the procedure devised using tubing connecting the vein to the spinal needle in a closed circuit was published in Jan Graziani's newsletter many years ago. It was an innovative approach at the time however the general feeling today, since we are more enlightened about matters of conscience, is that since the body is not feeding on the blood and it's entering the spinal column not the circulatory system it's a "matter of conscience." It is also a very effective way to treat spinal headaches that can be very debilitating.

Thanks for the feedback!

An epidural blood patch basically is a technique in which fresh autologous blood is injected in the epidural space, overlying the area where CSF is leaking from the spinal canal or subarachnoid space. The blood clots and seals the leak, thereby terminating the headache. It is quite safe and works immediately.

For the JW patient, one modifies the technique. One approach I have used is to first place a cannula in the patients vein, connected to a length of tubing and a distal stopcock and syringe. Once the epidural space has been located (typically a needle in the patient's back at the desired level), the tubing/stopcock/syringe ensemble is attched to the epidural needle. Then, blood is withdrawn into the tubing and syringe, and then directed into the patients epidural space.

Voila!

Continuity and contiguity are assured. The circuit and the blood remain within a closed-loop.

Most anesthesiologists nowadays are familar with these modifications - alternatively, you could e-mail the American Society of Anesthesiologists ot the Soc. for the Adv of Blood Management for a contact in your community.

Good luck.

Paul

Originally Posted by markeldredge

Very good explanation, Deborah. I had a patient that needed this procedure and was uncertain about whether she could conscientiously do it. She lived with a terrible headache for a week, then came back to the clinic and had the procedure done. In this case, she may have violated her own conscience in order to cure the headache. After going through this experience, a brother told me there is a procedure that would make this more acceptable to Witness patients using an IV tube to circulate the blood to where it's needed. Has anyone else heard of this procedure, and if so, would they be willing to share it with this group to pass on to our practitioners?

I am an Anaesthetic Technician working in Australia. I came up with this problem, and was asked by the Senior Anaethestist to come up with a solution.



We inserted a 16 gauge cannula into the R.C.F. while having the patient in left lateral position. After insertion of the touey needle L3/L4 (16g portex epidural kit) we connected an arterial extension kit with a male connection, to the cannula.



After loss of resistance we then connected a three way tap at the end of the touey needle with a second male connector, and then connected the other end of the arterial extension to the three way tap.



We now had a closed circuit so we attached a 20ml syringe to the three way tap and were able to draw venous blood into the epidural space via the three way tap.



This was done of course in a sterile manner.



I had to waste a few kits before hand, to get this system to work.



Hope this information will help

Could anyone help me with a couple of quick questions?
Although these solutions are certainly inventive, do they reflect the latest thinking on the matter? The Jehovah's Witness patient does not require a closed loop. The ones that object to having their blood withdrawn to place elsewhere on their body would reject it whether the delivery method is closed or not.

The Watchtower magazine, published by Jehovah's Witnesses, addresses this matter in a 2000 'Questions From Readers' article. The October 15th issue, pages 30 and 31 talked about just such a procedure.

"For example, during certain surgical procedures, some blood may be diverted from the body in a process called hemodilution. The blood remaining in the patient is diluted. Later, his blood in the external circuit is directed back into him, thus bringing his blood count closer to normal. Similarly, blood that flows into a wound may be captured and filtered so that the red cells can be returned to the patient; this is called cell salvage. In a different process, blood may be directed to a machine that temporarily carries on a function normally handled by body organs (for example, the heart, lungs, or kidneys). The blood from the machine is then returned to the patient. In other procedures, blood is diverted to a separator (centrifuge) so that damaging or defective portions of it can be eliminated. Or the goal may be to isolate some of a blood component and apply that elsewhere on the body. There are also tests in which a quantity of blood is withdrawn in order to tag it or to mix it with medicine, whereupon it is put back into the patient.
The details may vary, and new procedures, treatments, and tests will certainly be developed. It is not our place to analyze each variation and render a decision. A Christian must decide for himself how his own blood will be handled in the course of a surgical procedure, medical test, or current therapy.
Ahead of time, he should obtain from the doctor or technician the facts about what might be done with his blood during the procedure. Then he must decide according to what his conscience permits."

Another question from this thread that I am curious about- What, medically speaking is a closed-circuit? Would that involve an 'uninterrupted flow'? And if that is the case, what is a 'closed circuit cell saver'? The operation of a cell saver seems to need an interrupted circuit to clean and separate the waste and returned processed red cells back to the patient. Would that mean that there are no 'closed circuit' cell savers?

I appreciate you helping me to refine my understanding of these procedures and equipment!
Warren

Warren,

Thank you for expressing the gap that exists between spiritual and medical. As you so well presented, there is a lack of understanding in the interpretation of the use of medical procedures using one's own blood. It is very interesting that the terminology does not appear on the current DPA form but remains firmly rooted to these procedures by some.

In my reflections - trying to bridge the medical and spiritual realities - there seems to be two principal things to consider.

Stating principals in my own words ...

One who is struggling to identify which particular procedure is, or isn't, acceptable to thier conscience must ask:
In this particular procedure
1. Has the blood, in my view, left my body, therefore needing to be disposed of?
2. Has the blood been stored?

Therefore, with a extracorporeal circuit - one must decide, is it, in my view, still part of my body?
And with a process such as cell salvage, one must consider, with the blood flow being temporarily interrupted, has it, in my view been stored?

It is important to remember in these areas there are no clear rules - only principals.

But - the medical/spiritual gap is somewhat challenging! And the bridge is ricketey!

Actually the bridge is rickety from the untrained eye only. Things have not changed, only advances in the field of medicine have. Is it real or did I just think it to be so?