Another knotted epidural catheter
Randall Cork2006, Journal of Clinical Anesthesia
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Abstract
A lumbar epidural catheter inserted in a 24-year-old woman for labour analgesia, and subsequently used for postcaesarean epidural analgesia, proved difficult to remove. After multiple attempts, the entrapped catheter was dislodged intact, revealing a knot near its distal tip. Knotting of an epidural catheter leading to entrapment is a rare complication of epidural catheterization.
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On knots in epidural catheters: a case report and a review of the literature
International Journal of Obstetric Anesthesia, 2006
A lumbar epidural catheter placed for labor analgesia proved to be difficult to remove after an uneventful delivery. With the patient in the position of catheter insertion, i.e. seated, firm and steady traction allowed removal of the catheter and revealed a knot 4 mm from its tip. Passing excessive amount of catheter into the epidural space may have contributed to this complication. Guidelines to prevent and to minimize this complication are suggested.
Knotting of a Lumbar Epidural Catheter during its Removal: A Case Report
2017
Knotting of an epidural catheter is a rare complication during the removal of an epidural catheter. There are many factors for knotting of an epidural catheter, such as the characteristics of the catheter itself, patient's factors [anatomy, position during insertion and removal of the catheter, and the body mass index (BMI)], the difficulty of the procedure and the distance of advancing the catheter in epidural space. During its removal, we experienced a knot of a lumbar epidural catheter which was inserted for labor pain analgesia. The knot was successfully removed. In this case, the knotting was due to long distance advancement of the catheter, which was double knotted and looped in epidural space, far from its distal tip. To prevent this complication, catheters should be left with less than 6 cm in length in the epidural space.
Removing knotted or stuck epidural catheters: a systematic review of case reports
Anesthesia and Pain Medicine
Background: The knotting or in vivo entrapment of epidural catheters is an uncommon but challenging issue for anesthesiologists. This study aimed to identify the possible causes behind entrapped epidural catheters and the effective methods for their removal. Methods: A systematic review of relevant case reports and series was conducted using the Patient/population, intervention, comparison and outcome (PICO) framework and keywords such as “epidural,” “catheter,” “knotting,” “stuck,” “entrapped,” and “entrapment.” The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed, and the review was registered with International Prospective Register for Systematic Reviews (PROSPERO) (CRD42021291266). Results: The analysis included 59 cases with a mean depth of catheter insertion from the skin of 11.825 cm and an average duration of 8.17 h for the detection of non-functioning catheters. In 27 cases (45.8%), a radiological knot was found, with an ave...
Management and visualization of a kinked epidural catheter
A lumbar epidural catheter inserted in a 29-year-old woman for labor analgesia. The catheter failed to provide adequate analgesia. Moreover, after labor, it proved difficult to be removed. After computer tomography (CT) and magnetic resonance impedance (MRI) examination the course of the catheter was visible, the entrapped catheter was dislodged intact, revealing a kinking near its distal tip. Kinking of an epidural catheter leading to entrapment is an unusual complication of epidural catheterization.
Epidural catheter knot immediately after catheter insertion
Anaesthesia and intensive care
A 60-year-old female attended intensive care for insertion of a dialysis-access catheter for urgent haemodialysis. Following the insertion of a 20 cm pre-curved Niagara™ Dual Lumen Short-Term dialysis catheter (BARD Access Systems Inc., Salt Lake City, UT, USA) under ultrasound guidance via the right internal jugular vein, a chest X-ray was ordered to confirm the correct positioning of the catheter tip. The chest X-ray showed the catheter to be extending beyond the junction of the superior vena cava and right atrium, in spite of following standard practice guidelines 1,2 . The patient was also noted to have an episode of non-sustained ventricular tachycardia post insertion of the catheter. Measurement of the inserted catheter length was undertaken on the chest X-ray and found to be approximately 25 cm in length, which exceeded by 5 cm the length reported by the company on their package insert. The catheter was withdrawn by 7 cm, with repeat chest X-ray demonstrating it to be in a suitable position. The remaining contents of the catheter pack were salvaged and the venous stylet used during the procedure measured, from the tip to beginning of the curve, 24 cm. Unlike central venous catheters, where centimetre interval markings are used to indicate the length of insertion, there are no markings present on most dialysis-access catheters that are on the market. In particular, in the case of precurved dialysis-access catheters, insertion to the point at which the catheter becomes curved (the pre-specified point) poses a potential problem in the absence of interval centimetre markings on these catheters. Interval centimetre length markings become even more critical, whether straight or pre-curved, if they are inserted via right or left internal jugular or subclavian vein routes (rather than insertion via the femoral route). In these situations, the catheters are placed by proceduralists with the assumption that the length (depth) of insertion of the catheter is appropriate prior to confirming the catheter tip position on the chest X-ray, whether inserted by using standard surface anatomical landmarks (blind techniques) or by using ultrasound techniques, aiming to stop advancing beyond the upper portion of the right atrium or the atrio-caval junction to prevent unintended serious cardiovascular complications. A few centimetres difference in length (depth) of insertion compared to the appropriate length (depth) of insertion of these large-bore catheters can make a huge difference to the successful functioning of the dialysis catheters and dialysis. If inserted too short a length (depth), catheter malfunction is high and, if too long, unintended consequences are high.
A new method for epidural catheter fixation
Aǧrı : Ağrı (Algoloji) Derneği'nin Yayın organıdır = The journal of the Turkish Society of Algology, 2007
We investigated the effect of a new fixator made from a medication port of a intravenous fluid container on the migration of epidural catheter. Fifty patients were recruited to receive epidural analgesia and allocated to one of two groups. In the new fixator group (n=25) epidural catheter was advanced through a fixator then fixed with transparent adhesive dressing, in the standard dressing group (n=25), the catheter was fixed only with transparent adhesive dressing. Outward migration of the catheter over 2 cm, and inward migration over 1 cm was described as the failure of the fixation. At the end of the follow up time, outward migration or inward migration distance, and the reason for removing the catheter were recorded. In the standard dressing group, outward migration was detected in 7 patients compared to 2 patients in the new fixator group (p>0.05). Inward migration was determined in only 5 cases in the standard dressing group (p<0.05). There was no movement in 13 cases in...
Epidural catheter fixation. A comparison of subcutaneous tunneling versus device fixation technique
Journal of anaesthesiology, clinical pharmacology
The technique of securing the epidural catheter has a major bearing on the efficacy of epidural analgesia. Specific fixator devices, for e.g., Lockit epidural catheter clamp, which successfully prevents catheter migration, are available. The possibility of catheter snapping and surgical retrieval has been reported with tunneling of catheters. These techniques have not been compared for safety, efficacy and appropriateness of achieving secure epidural catheter fixation in the postoperative period. A total of 200 patients who required postoperative epidural analgesia were included. They were randomized into two groups: Group I (n = 100) in whom epidural catheters were tunneled vertically in the paravertebral subcutaneous tissue and group II (n = 100) wherein a Lockit device was used to fix the catheter. Likert score was used to quantify patient's comfort during procedure. The techniques were compared for migration, catheter dislodgement, local trauma, catheter snapping and cathete...
Tunneling and Suture of Thoracic Epidural Catheters Decrease the Incidence of Catheter Dislodgement
The Scientific World Journal, 2014
Background.Dislocation of epidural catheters (EC) is associated with early termination of regional analgesia and rare complications like epidural bleeding. We tested the hypothesis that maximum effort in fixation by tunneling and suture decreases the incidence of catheter dislocation.Methods.Patients scheduled for major surgery (n=121) were prospectively randomized in 2 groups. Thoracic EC were subcutaneously tunneled and sutured (tunneled) or fixed with adhesive tape (taped). The difference of EC length at skin surface level immediately after insertion and before removal was determined and the absolute values were averaged. Postoperative pain was evaluated by numeric rating scale twice daily and EC tips were screened microbiologically after removal.Results.Both groups did not differ with respect to treatment duration (tunneled: 109 hours ±46, taped:97±37) and postoperative pain scores. Tunneling significantly reduced average extent (tunneled: 3 mm ±7, taped:10±18) and incidence of ...
Dislodgement of epidural catheters in labour
Anaesthesia, 2001
Letters (two copies) must be typewritten on one side of the paper only and double spaced with wide margins. Copy should be prepared in the usual style and format of the Correspondence section. Authors must follow the advice about references and other matters contained in the Notice to Contributors to Anaesthesia. The degree and diplomas of each author must be given in a covering letter personally signed by all the authors. Correspondence presented in any other style or format may be the subject of considerable delay and may be returned to the author for revision. If the letter comments on a published article in Anaesthesia, please send three copies; otherwise two copies of your letter will suffice. More recently, the Registry has been expanded to haematological and other intercurrent medical diseases. The success of the project depends on the spirit of cooperation amongst our members; the cardiorespiratory Registry has over 270 cases ranging from mild to lifethreatening, while the neurological Registry has over 100 cases. To date, the information arising from the Registry has been presented at OAA meetings, although a bulletin of cardiorespiratory cases was produced in 1998 and the first formal paper has just been submitted for publication. We are also discussing the use of the Internet for the future [2]. We are aware that we have collected a considerable combined experience in the use of anaesthesia and analgesia in women with cardiorespiratory and neurological disease that is relevant to all anaesthetists, not just obstetric ones. The value of this Registry has been recognised by our members and also the Royal College of Obstetricians and Gynaecologists, which is interested in the obstetric and neonatal outcomes of these women. This type of collaborative venture is something that the NHS as a whole may wish to develop for all high-risk cases, and not just for adverse events. We agree, though, with Dr Mason that it is a pity the recent report of an expert group on learning from adverse events in the NHS did not have anaesthetic involvement.
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Journal of Clinical Anesthesia, 2007
Epidural anesthesia is a safe procedure and is routinely performed by the anesthesiologists. Breakage of an epidural catheter is a rare, but a worrisome complication. However, if this happens, the presence of retained epidural catheter fragment should be properly documented and should also be informed to the surgical team and the patient. Here, we present two cases of such an event and also highlighting the common reasons that could have precipitated that event.
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Failure to inject a drug through the epidural catheter because of epidural catheter connector malfunction is a rare complication. In this report, we describe a case of epidural catheter -connector malfunction in a 45 years old male undergoing emergency explorative laparotomy for haemoperitoneum under general anaesthesia and insertion of epidural catheter for post operative analgesia. After insertion of catheter after completion of surgery, drug could not be injected in the catheter. After common causes like kinking, knotting, occluded catheter were ruled out, the cause was found to be in the epidural catheter connector assembly which is not encountered frequently. This case warrants that anaesthesiologists must also be aware of rare causes and the preventive steps to avoid such complications.
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Breakage of an Epidural Catheter Inserted for Labor Analgesia
Turkish Journal of Anesthesia and Reanimation, 2015
The breakage of an epidural catheter, which is usually not noticed, is a rare but important complication encountered while inserting or removing the catheter during epidural blockade. While the epidural catheter was being inserted for labor analgesia, despite no problem being encountered in advancing the catheter, it was drawn back to verify the location; it was observed that 2 cm of the distal end of the catheter was missing. A neurosurgical consultation was requested; it was reported that the broken piece would not create any problems and reintervention could be performed for labor analgesia. An epidural catheter was reinserted and was used for analgesia without any problem until delivery. Although nine months have passed, no problem was defined by the patient. If epidural catheter has to be removed while the Tuohy needle is still in place, we recommend that they should be removed together to minimize the risk of a possible breakage. We think that the decision for surgery and imaging can be performed based on the individual patient's clinical picture.
A broken catheter in the epidural space
Neurosciences (Riyadh, Saudi Arabia), 2014
The Arrow FlexTip epidural catheter has reinforced coiled stainless steel wire, which facilitates its insertion and is less likely to puncture the blood vessels. However, as compared with non-reinforced, reinforced epidural catheters are more vulnerable to break. We report a case from Saudi Arabia on a retained fragment of a broken epidural catheter. Measures to prevent this mishap and its management are discussed.
Management of an Epidural Catheter Rupture: A Case Report
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Breakage During Removal of an Entrapped Wire Reinforced Epidural Catheter
Science Journal of Clinical Medicine, 2019
Wire-reinforced epidural catheters exhibit certain advantages, such as greater resistance and flexibility, since they are made of a metal spiral shaped structure coated with a polyurethane layer. Due to the flexibility of its tip, epidural catheters reinforced with wire, lead to reduced risk of complications, such as intravenous and intrathecal catheters, epidural hematoma, systemic absorption of the local anesthetic, and transient paresthesia. The lower incidence of paresthesia would be related to the catheter's reduced stiffness. Despite the various benefits observed, there are numerous reports in the literature showing difficulty in wire-reinforced epidural catheters. We report a case of wire-reinforced epidural catheter removal difficulty and discuss possible measures to be adopted in these circumstances.
The Breaking of an Intrathecally-Placed Epidural Catheter During Extraction
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Muscle relaxant or prone position, which one unfastened the entrapped epidural catheter?
Saudi Journal of Anaesthesia, 2015
Some nonsurgical steps have been introduced to remove an entrapped catheter. But occasionally, the majority of them fail, and we are forced to extract the catheter through an invasive procedure. This article depicts our team's experience on the issue. When we found that the inserted epidural catheter was entrapped, we performed all recommended noninvasive maneuvers to release the catheter, but no progress was achieved. Therefore, after obtaining informed consent, we induced anesthesia and changed her to a prone position to explore her back. The intact catheter was removed easily in this stage. The authors believe, in this process, it would have been better if they had tried pulling the catheter in a prone position as a preliminary step. Furthermore, pulling the catheter in a prone position after injecting a muscle relaxant appeared to be more effective and saved the patient from the scheduled surgery.
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