II. Mechanism

  1. Blood is a procoagulant
    1. When injected within the epidural space, blood collects on the dural membrane inner surface
    2. Injected blood forms a clot, effectively plugging a CSF leak (Spinal Headache cause)

III. Technique

  1. Patient's blood (20-30 cc) is collected using sterile technique
  2. Epidural needle inserted into epidural space
    1. Insertion site at the site of the prior Lumbar Puncture (leak site) or below that site
    2. Needle is inserted through ligamentum flavum (crunchy) and then a pop is felt
    3. Inject a small amount of saline or air while advancing needle
      1. Resistance is lost when epidural space is entered
      2. Some providers prefer injecting air, as saline may be confused with CSF
    4. CSF flow on insertion indicates the needle has punctured the dura (too deep)
      1. Dural puncture complicates >1% of blood patches (even in experienced hands)
      2. Do NOT inject blood into the subdural space (risk of arachnoiditis, infection)
  3. Patient's blood (20-30 cc) is injected via epidural needle into epidural space
    1. Blood dissipates at least 9-10 levels while patient is in the supine position

IV. Adverse Effects

  1. Back Pain (35% of cases)
  2. Dural Puncture (>1%)
  3. Subdural Injection of Blood
    1. Risk of arachnoiditis or infection
  4. Recurrent Headache due to loss of blood patch (40% of cases)
    1. Patients should avoid straining, bending and heavy lifting after the blood patch

V. References

  1. Claudius and Darras in Herbert (2018) EM:Rap 18(11):12-3

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Ontology: Blood Patch, Epidural (C0162649)

Definition (MSH) The injection of autologous blood into the epidural space either as a prophylactic treatment immediately following an epidural puncture or for treatment of headache as a result of an epidural puncture.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D017217
ICD9 03.95
ICD10 38 , 18233-00
SnomedCT 447366001, 171794006, 56721008
CPT 62273
English Epidural Blood Patch, Blood Patchs, Epidural, Epidural Blood Patchs, Patch, Epidural Blood, Patchs, Epidural Blood, Epidural blood patch, Inject epidural patch, spinal blood patch (treatment), spinal blood patch, Spinal patch, Injection, epidural, of blood or clot patch, blood patch epidural, epidural blood patch, Injection of autologous whole blood into spinal epidural space, Injection of autologous whole blood into spinal epidural space (procedure), Spinal blood patch, Blood Patch, Epidural, INJECTION EPIDURAL BLOOD/CLOT PATCH, Epidural injection of blood, Injection of blood or blood clot into spinal canal, Epidural injection of clot patch, Epidural blood patch (specimen), Epidural lumbar injection of blood patch, Epidural lumbar injection of blood patch (procedure), INJECT EPIDURAL PATCH
Italian Chiazza ematica epidurale, Blood patch epidurale
French Blood patch péridural, Colmatage sanguin épidural, Pansement de sang épidural, CSE (Colmatage Sanguin Épidural), PSE (Pansement de Sang Épidural), Patch sanguin épidural
Swedish Blodinjektion, epidural
Japanese コウマクガイケツエキパッチ, 血液パッチ法-硬膜外, 硬膜外血液パッチ法, 硬膜外血液パッチ
Czech epidurální aplikace krve, Epidurální krevní zátka
Finnish Epiduraalinen veripaikka
Russian KROVIANOI SGUSTOK EPIDURAL'NYI, KROVIANAIA PLOMBA EPIDURAL'NAIA, EPIDURAL'NAIA KROVIANAIA PLOMBA, КРОВЯНАЯ ПЛОМБА ЭПИДУРАЛЬНАЯ, КРОВЯНОЙ СГУСТОК ЭПИДУРАЛЬНЫЙ, ЭПИДУРАЛЬНАЯ КРОВЯНАЯ ПЛОМБА
Polish Wstrzyknięcia krwi nadtwardówkowe, Wstrzyknięcie autologicznej krwi do przestrzeni nadtwardówkowej
Spanish inyección de sangre entera autóloga en espacio epidural raquídeo, inyección de sangre entera autóloga en espacio epidural raquídeo (procedimiento), inyección lumbar epidural de un parche de sangre (procedimiento), inyección lumbar epidural de un parche de sangre, Parche hemático epidural, Parche de Sangre Epidural
Hungarian Epiduralis koagulumképzés
Norwegian Blodpatch, epidural, Blodinjeksjon, epidural, Epidural blodinjeksjon
Portuguese Placa sanguínea epidural, Placa de Sangue Epidural
Dutch epidurale bloedpatch, Bloedinjectie, epidurale, Bloedpatch, epidurale
German Epiduraler Blutpatch, Blutinjektion, epidurale, Epidurale autologe Blutinjektion