Tuohy Needle

Description

Non-coring type needle with a transversely curved wall and side hole giving it a long, sharp, curved tip.

Differs from a typical needle where the opening of the needle is at the tip of the needle itself. The Tuohy Needle has a directional tip which allows a catheter to be directed as it exits the needle, increasing the accuracy of placement. Used to administer epidural anaesthesia

History of the Tuohy Needle

1906 – Henry Percy Dean described the use of continuous spinal anaesthesia momentum in with its use by in surgical patients

1940 – William Lemmon started to use continuous spinal anesthesia in surgical patients. This was achieved with a malleable needle that stayed in situ, this however made lumbar puncture difficult, was impracticable due to the risk of dislodgement and there was a high rate of needle breakage

1944 – Tuohy, a captain in the US Army Medical Corps, first described the use of an indwelling nylon urethral catheter for continuous spinal anaesthesia. Using the catheter technique, he describes fewer complications and achieved good analgesia. However, the problem remained that the catheter could migrate through the epidural space when introduced using a straight needle

Original description of the ‘Tuohy needle’ came from Ralph Lee Huber and was patented in 1946; it was a continuation of his hypodermic needle in 1943

1945 – Tuohy first used a 15-gauge needle with a ‘Huber point’, a curved tip with a lateral orifice. This allowed directional insertion of a catheter either cephalad or caudate. He used the lateral opening for directional placement of a catheter for administration of anaesthetic into the subarachnoid space and subsequently the epidural space

Originated from Tuohy attempting to improve previously described techniques for placement of catheters; he had concerns regarding introduction and stabilization of the catheter as well as concerns over trauma caused to tissues by the needle. Prior to using the directional tipped needle for catheter placement, Tuohy suggested bending the catheter prior to insertion. Tuohy added a stylet which reduced the risk of skin plugging

1949 – Curbelo described the use of the needle design for placement of the epidural catheter to provide continuous anaethesia

During my last visit to the Mayo Clinic, in November, 1946, I had an opportunity to see Dr. E. B. Tuohy perform continuous spinal anesthesia by means of a ureteral catheter introduced in the subarachnoid space through a needle with Huber point. I decided to use a similar procedure for continuous segmental peridural anesthesia

Curbelo MM, 1949

Associated Persons

• Edward Boyce Tuohy (1908-1959)
• Ralph Lee Huber (1889-1953)

Alternative names

• Huber Point Needle

Controversies

Although Huber patented the needle he did not publish any papers demonstrating its use. The Tuohy needle was designed for use in continuous spinal anesthesia since and was first popularized in 1945. In Tuohy’s original work, in 1945, he describes a 15-gauge needle with ‘Huber point’ but he makes no reference to origin of the ‘Huber point’

Ralph Lee Huber (1890-1953) was a dentist in Seattle and an avid inventor. In 1946, he applied for a patent on a needle with a ‘transversely curved wall…end portion’. Huber made many of his inventions available to the US Army during the war, including the Huber point which was adopted by the Army in 1942 and it is possible that Tuohy first encountered the Huber point during his time in the US Army.

Although Tuohy’s original description of his needle made no reference to the origin of the Huber point he claimed no originality for the design as he described the needle with a Huber point

References

Original articles

• Tuohy EB. Continuous Spinal Anaesthesia: Its usefulness and technic involved. Anesthesiology 1944;5:142-148
• Tuohy EB. Continuous Spinal Anaesthesia: A new method utilizing a ureteral catheter. Surg clin North AM 1945;25:834-840
• Curbello MM. Continuous Peridural Segmental Anesthesia by Means of a Ureteral Catheter. Curr Res Anesth Analg. 1949 Jan-Feb;28(1):13-23

Eponymous term review

• Frölich MA, Caton D. Pioneers in epidural needle design. Anesth Analg. 2001 Jul;93(1):215-20.
• Martini JA, Bacon DR, Vasdev GM. Edward Tuohy: The man, his needle, and its place in obstetric analgesia. Reg Anesth Pain Med. 2002 Sep-Oct;27(5):520-3.
• Lubisich JW. Ralph L. Huber, DMD: forgotten inventor of the “Tuohy” needle. J Hist Dent. 2004 Jul;52(2):75-9

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