FAQs
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Frequently Asked Questions for Anesthesia Providers


What are the advantages of using the Episure AutoDetect syringe for epidural placements?
Episure AutoDetect allows you to continuously keep both hands on the epidural needle during advancement. Anesthesia providers using the Episure AutoDetect have reported significantly increased control because of this. Our syringe also provides an objective, visual indicator of loss of resistance when the EDS has been reached, rather than relying on the subjective “feel” for loss of resistance (LOR) required with traditional LOR syringes.

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What are the disadvantages of using the Episure AutoDetect syringe for epidural placements?
Based upon feedback thus far, Indigo Orb has not identified any disadvantages to using the Episure AutoDetect syringe.

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Do I have to change the way I perform my epidurals?
No, that is what makes the Episure AutoDetect so easy to use. You perform the epidural placement in the same manner that you are accustomed to. The only difference is that you use the Episure AutoDetect syringe instead of your standard LOR syringe.

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Will there be a false LOR if the patient has a “mushy” ligament?
Based upon feedback received from our European distribution, as well as from a clinical study in the United States, this does not appear to be any more of an issue than with standard LOR syringes. There can be slight, slow movement in the plunger as the needle passes through a “mushy ligament” or fatty tissue (similar to what is seen with standard LOR syringes). This is not the TRUE Loss of Resistance. When the needle enters the epidural space, the plunger depresses steadily and fully. This constitutes the true Loss of Resistance indicating that the Epidural Space has been reached. We recommend advancing the epidural needle into the interspinous ligament before attaching the Episure AutoDetect syringe to minimize this issue.

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Are there any studies evaluating Episure AutoDetect?
Yes, a two part case series was performed at a Stanford University and the physician feedback has been very positive. There is also a larger, multi-center study underway currently. Please refer to the Clinical Study section in our website for more details.

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Will Episure AutoDetect prevent me from getting an accidental dural puncture?
Indigo Orb believes that using Episure AutoDetect enhances the anesthesia provider's ability to identify the epidural space. However, just as with traditional LOR syringes, the anesthesia provider must stop advancing the needle once the epidural space has been identified. Currently, there is no mechanism which prevents someone from continuing to advance the epidural needle beyond this point, but Indigo Orb is researching this area.

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In the event of an accidental dural puncture, would the Episure AutoDetect inject saline into the subarachnoid space?
Because of the normally low CSF pressure, Episure AutoDetect may expel saline into the subarachnoid space in the event of an Accidental Dural Puncture (ADP). This is not unlike what can happen when an ADP occurs with a traditional LOR syringe, ie, a small amount of saline is often injected into the subarachnoid space before the dural puncture has been recognized. This small amount of saline should be of no clinical significance.

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Can the Episure AutoDetect be filled with air?
Saline is recommended when using the Episure AutoDetect syringe.

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What is the recommended procedure when you have to withdraw and redirect the Tuohy needle during epidural placement?
If withdrawal and redirection of the Tuohy needle are required, it is possible that some of the saline will be expelled into the fatty/connective tissue during this process. This is because the unique design of the Episure AutoDetect maintains constant tension on the plunger; thus, fluid can be expelled if the needle passes through soft, fatty tissue. If this is noted to occur and it is interfering with placement of the epidural, two maneuvers can be used. First, some practitioners have described holding the plunger in the retracted position during redirection of the Tuohy needle. Second, some practitioners detach the Episure AutoDetect from the Tuohy needle during withdrawal/redirection, and then re-attach it after the Tuohy needle has been placed into the ligament.

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I have placed lots of epidurals with standard LOR syringes, why should I use something different?
The Episure AutoDetect syringe provides improved control and sensitivity, even for experienced practitioners. This is because both hands continuously remain on the needle during advancement.

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I am a resident and haven't performed many epidurals, should I use Episure AutoDetect?
Yes, an academic anesthesiologist described Episure AutoDetect as “excellent for teaching” because it allows trainees to more quickly develop a feel for the tissues because both hands are used to advance the needle.

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Will the Episure AutoDetect work for Thoracic or Cervical epidurals?
The Episure AutoDetect has not yet been tested in thoracic or cervical epidurals and is, thus, not for use in these areas of the spine.

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Has the Episure AutoDetect been tested in pediatrics?
The Episure AutoDetect has not yet been tested in pediatric patients, and is , therefore, not recommended for use in this patient population.

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Is the Episure AutoDetect FDA cleared?
Yes.

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Where can I get Episure AutoDetect?
Please email your inquiries to sales@indigo-orb.com.

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Where can I get more information about Episure AutoDetect?
Please email your inquiries to sales@indigo-orb.com.

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