Clearly this catheter is still intravascular in spite of your attempts to pull it back and dislodge it from the epidural vein it is in. 

It all fits. 

The initial bolus lasted about 1.5 to 2 hours and by the time the nurse got around to calling you back three hours had passed.  The 10 ml/hour infusion went intravascular, but because the rate of the infusion and the concentration of bupivacaine are so low, the patient didn't detect any CNS effects.


a. Pull the catheter back further and test with aspiration

b. You pull the catheter back and test with an epinephrine solution

c. Replace the catheter


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