Spinal Anesthesia Teaching Module:
Spinal Anesthesia Procedural Checklist
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Take a ‘time out’ to verify:
- the patient’s identity
- the procedure that is being done
- whether consent has been obtained
- the site
Places pulse oximeter and NIBP cuff on patient
Verify that spinal kit tray, nonsterile and sterile
gloves (correct size), and cleansing solution are
present
Palpate the superior aspects of the iliac crests and
identify the intersection at the L4 spinous process
with non-sterile gloves on. Use skin-indentation to
indicate the proper position at the L3/L4 or L4/L5
interspace
Clean the overlying skin with chlorhexidine in
widening concentric circles
(note: American Society of Regional Anesthesia
currently recommends chlorhexidine for skin
antisepsis prior to regional anesthesia procedures)
Open the spinal tray before placing sterile gloves on
Put on sterile gloves with proper technique (remove
jewelry, ID badge, wash hands, etc.)
Apply sterile drapes
Verify the content of the anesthetics before drawing it
up. Draw up lidocaine in the 3cc syringe and
bupivacaine in the 5cc syringe. Warn the patient you
are about to administer local anesthesia.
Re-identify the intended interspace after the patient is
prepared and draped.
Using the smallest provided needle, make a wheal of
local anesthesia at the previously marked site
Ask assistant to add morphine to bupivacaine syringe
Inject anesthetic in the correct location and angle:
-superior aspect of the inferior spinous process,
-in the midline,
-approximately 15 degrees cephalad, as if aiming at
the umbilicus);
- Horizontal plane perpendicular to patient’s back (eg
maintaining needle in midline position)
Insert the introducer needle in the middle of the
interspace with a slight cephalad angulation of 10 to
15 degree. The bevel of the spinal needle should be in
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the sagittal plane and advance in the orientation as
described above.
Advance through the anatomic structures until the
subarachnoid space is reached. May experience a
popping sensation as the ligamentum flavum is
crossed.
Withdraw the stylet each time you feel a pop to
assess for CSF flow.
If attempt is unsuccessful (bone encountered, no CSF
flow, etc), withdraw the introducer needle and spinal
needle to the subcutaneous tissue (without exiting the
skin) and redirect the introducer needle.
Confirms CSF flow by aspiration before and after
injecting anesthetic
Remove the spinal and introducer needle together
once completed.
Apply pressure with the provided 2x2 gauze, assess
for good hemostasis.
Remove the draping. Lay the patient and observe
vitals. Dispose of all sharps and biohazard material
appropriately.
Please circle any of the following complications if they occurred:
Paresthesia
Innapropriate Glove
Size
Poor positioning
Same exact needle
maneuver more than
two consecutive
times
Needle insertion at
high-lumbar or lowthoracic interspace
Angle inconsistent
with obtaining CSF
Finder needle
inserted into
different area from
local anesthesia
Medication injected
without CSF
confirmation
Bent needle
Possible breaks in
aseptic technique
CSF during removal
of needle
Spinal Anesthesia Minimum Passing Score:
These items must be completed for the residents:
1. Performs a procedural time out
2. Places NIBP and pulse oximeter on patient
3. Maintains sterility (cleans skin, removes jewelry, technique)
4. Confirms CSF flow before and after injecting anesthetic
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What is your global assessment of the resident’s performance of this spinal block? Please
circle.
Needs Improvement Marginal Competent/Adequate Very Effective Exemplary
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