title: Epidural blood patch in Jehovah's Witness: two cases report.
abstract: OBJECTIVE
  There are reports on epidural blood patch in Jehovah's Witness patients using a closed system which allows blood collection and epidural injection without loss of continuity. This report aimed at presenting two cases of Jehovah's Witness patients with post-dural puncture headache and treated with epidural blood patch in a closed venous blood transfusion system to the epidural space. Cases were reported by two different hospitals in two different cities.
  
  
  METHODS
  One 21 years old male patient and one 32 years old female patient, with post-dural puncture headache after outpatient procedures. Since they were Jehovah's Witnesses, blood patch was performed with a closed system. System was prepared in sterile conditions using the following materials: two serum catheters cut in 60 cm segments, one two-way connection, one three-way tap and one 20 ml syringe. System was assembled to allow one connection to the puncture needle (20G), one connection to the three-way tap and the remaining two ways were connected to a 20 ml syringe and to the other serum catheter segment, which would be connected to the epidural needle. Lumbar region and right upper limb were disinfected with patients in the left lateral position. Epidural puncture was performed at L2-L3 interspace with 17G needle which was maintained fixed and connected to the serum catheter. Then, venous puncture was performed with a needle connected to the other edge of the serum catheter with the three-way tap directed from the vein to the syringe and 15 ml blood were aspirated. Redirecting the tap from the syringe to the epidural needle, the same 15 ml blood were re-injected.
  
  
  CONCLUSIONS
  In Jehovah's Witness patients refractory to clinical treatment, autologous blood injection may be performed through the above-described technique after patients informed consent.
authors.affiliation: CET/SBA, Instituto Penido Burnier, Centro Médico de Campinas, Campinas, SP.
authors.forename: Luciano de Andrade
authors.initials: Lde A
authors.lastname: Silva
authors.forename: Daniel
authors.initials: D
authors.lastname: de Carli
authors.forename: Luiz Marciano
authors.initials: LM
authors.lastname: Cangiani
authors.forename: José Bonifácio Mendes
authors.initials: JB
authors.lastname: Gonçalves Filho
authors.forename: Iara Ferreira
authors.initials: IF
authors.lastname: da Silva