Incidental epidural fluid collection – differential approach considerations

Abstract

When patient care requires spinal/epidural needle re-entry at the same level as a recent spinal/epidural procedure, clear fluid may appear at the needle hub. This fluid has a differential: it may be iatrogenic, cerebrospinal fluid that leaked following a prior dural puncture, or cerebrospinal fluid freshly drawn from the spinal column. To date, there is no clear guideline on how to navigate this situation. In this brief case series, we present two distinct clinical scenarios that require properly identifying the source and nature of this fluid. We also highlight the lack of a standardized approach to differentiating clear fluid at the spinal/epidural needle hub, discuss our thoughts on how this can be rectified and what point-of-care tools may be useful. Key words: Case Report; Epidural Anesthesia; Epidural Blood Patch; Point-Of-Care Testing; Spinal Anesthesia Citation:  Khan E, Rozenfeld L, Nawaz S, Khamash O, Girshin S, Woodruff B, Mendonca R. Incidental epidural fluid collection – differential approach considerations. Anaesth. pain intensive care 2023;27(5):619−621; DOI: 10.35975/apic.v27i5.2321 Received: May 23, 2023; Reviewed: June 27, 2023; Accepted: August 10, 2023