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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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Routine administration of prophylactic antibiotics is warranted prior to any intrathecal implantation based on the significance of the infection. Appropriate agents include cefazolin 1 to 2 gm IV 30 minutes prior to incision, clindamycin 900 mg IV 30 minutes prior to incision, or vancomycin 1 gm IV over 60 minutes prior to incision. Discuss the location of the pump with the patient prior to surgery, and then mark the site using a skin marker with the patient in the sitting position. Make sure that CSF flows freely from the intrathecal catheter at each step during the implantation to ensure early detection of incorrect placement or dislodgement. Ensure that the size of the pocket created for the pump is adequate to prevent tension on the suture line following wound closure. Use caution when placing the fascial closure sutures. Know where the catheter lies at all times to avoid damaging the catheter with the suture needle.

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