A modified Dawkins epidural indicator: A useful teaching aid
A modified Dawkins epidural indicator may be assembled with inexpensive, disposable, sterile components found in any American hospital. It consists of the barrel of a standard tuberculin or 1-cc (long) insulin syringe which is attached to a 3-way plastic stopcock, which in turn is attached to the hub of the epidural needle so that the barrel is at right angles to the needle shaft in the vertical plane. The total weight is 5.3 g. The device is operational when the barrel is filled with sterile saline. It is attached to the hub of the needle when the tip is close to the ligamentum flavum. The entire unit is advanced toward the dura while closely observing the meniscus. As the needle enters the epidural space downward, movement of the meniscus is seen. If inadvertent puncture of the dura should occur, upward movement of the meniscus is seen as the tube fills with cerebrospinal fluid. The subarachnoid position of the needle may be also confirmed by a Valsalva maneuver causing upward movement of the meniscus.