Wiley Spinal™

1. Place patient in seated position. Prep lower back with prep sponge.

2. Apply fenestrated drape with orifice over L4/L5 interspace. Midline or paramedian approach may be used. Create skin wheal in midline just cephalad to the L5 spinous process. Use lidocaine with epinephrine on skin wheal to reduce bleeding.

3. Insert peel away introducer with wings oriented laterally and advance hub to skin.

4. Remove the needle from peel away introducer. If redirection is required, remove entire device from patient first, then reinsert assembly.

5. Align black triangles on pencil point/Wiley Spinal hub for cephalad orientation and carefully insert Wiley Spinal through peel away introducer with a two handed technique, placing hand closest to patient on cannula and the other hand on clear needle hub. Use steady gentle pressure, as the Wiley Spinal advances. Successful trajectory will result in smooth resistance of the spinal ligaments and ligamentum flavum ending with a distinctive "give" or "click" as the needle tip passes through the dura. If bone is encountered, pull back and alter trajectory.

6. Remove needle's stylet and observe the flow of clear CSF. When CSF is detected, advance Wiley Spinal needle and cannula 1-2mm to ensure both spinal needle and flexible cannula have penetrated dura.

7. Stabilize the cannula hub and rotate clear needle hub counterclockwise 360° until both black triangles are visibly aligned and oriented cephalad.

8. Continue to stabilize clear needle hub and slowly advance flexible cannula off spinal needle until hub reaches peel away introducer.

9. Grasp both wings of peel away introducer, pull laterally along skin, split and peel out. Observe the hub for continued flow of clear CSF before advancing hub to patient's skin.

10. Spinal needle may be removed.

11. Insert Wik-Wire into cannula hub and advance until the leur-lock of the extension tubing can be tightly secured. Passive filling is preferred over aspiration or priming extension tubing. If CSF is not seen, slowly withdraw cannula until CSF appears, then secure in place.

12. Properly secure cannula hub flush against patient's skin before titration of anesthesia and apply adhesive dressing over hub and extension tubing.

13. Titrate medication for desired anesthetic result.