SummaryThe incidence and amount of migration of epidural catheters was investigated in a prospective randomised study of 153 women who required analgesia in labour. Inward or outward migration occurred in 36% of patients. Inward migration by 1-3 cm occurred in 21 (13.7%) patients and outward migration by I cm or more occurred in 34 (22.2%); three (2%) catheters migrated out rhrough the skin. There were SigniJicant positive correlations between outward migration and weight, body mass index, and depth of the epidural space. There was no relationship between migration and height, age, intervertebral space used or duration of catheterisation. Problems with epidural block were no more likely in patients in whom migration of I cm or more occurred compared with those in whom migration was limited to a maximum of f 0.5 cm. However, the pattern of problems was different. All cases of failed epidural block occurred in patients whose epidural catheter migrated outward by 2.5 cm or more. Unilateral blockade was not more likely i f migration of I cm or more occurred. Key wordsEquipment; epdural catheters. Complications; migration.Epidural catheters are used during labour in approximately 30% of patients who deliver in our hospital. Migration of the epidural catheter after it has been fixed to the skin has already been shown to occur [I]. Hazards of migration include inadvertent intravenous [2,3] or subarachnoid [4,5] injection and unilateral or failed block [6]. A fixation method with a low incidence of migration, and a means of predicting patients in whom migration is likely, are both desirable. Duffy [7] reported that none of 200 catheters migrated when secured with Opsite transparent dressing. We collected data in order to identify factors which might influence the degree of epidural migration. We used three different standard techniques of fixing the catheter to the skin. Patients and methodsWomen who requested analgesia in normal labour, and those in whom epidural analgesia was indicated for medical reasons (breech presentation, intra-uterine death, or pregnancy-induced hypertension) were eligible for entry into the trial. Patients were not studied if the coagulation profile was abnormal, if it was not technically possible to site the epidural catheter with the patient in the left lateral position, if epidural analgesia was ineffective after injection of 10 ml bupivacaine 0.5% and 10 ml bupivacaine 0.25%, or if dural puncture occurred.Patients were allocated randomly to receive one of three methods of skin fixation according to a previously prepared list. The age, height and most recent weight in the antenatal clinic were recorded for each patient, and body mass index (BMI) calculated from the equation: BMI = weight (kg)/height*(m).After establishing an intravenous infusion of compound sodium lactate solution an epidural catheter was inserted by one of four anaesthetists, with the patient in the left lateral position. The L2-3 or L,, interspace was identified by palpation of the iliac crests and spinous processes.Lignoc...
Objective. To assess the reproducibility of treatment methodology detailed in contemporary published clinical trial reports. Design. Published articles focusing on clinical trials involving the administration of chemotherapy for the treatment of cancer were selected. The data required for the administration of chemotherapy was determined by an experienced oncology pharmacist. Outcome measures. The degree of potential impact of the omission of relevant detail was assessed. The overall reproducibility of the methodology was then classified as reproducible, reproducible with further literature evaluation, or not reproducible without communication with the authors. Results. Ninety-two articles were reviewed. Ninety percent of articles omitted data required to enable reproduction of the methodology. Of these, 5.4% omitted essential data which could only be obtained by communication with the authors. Over 57% of articles required further detailed literature evaluation before the methodology could be reproduced. A number of articles contained errors or ambiguity. Discussion. The focus of the article and journal contributed to the completeness of the methodology. Guidelines for the preparation of manuscripts for publication in biomedical journals need to be reviewed. Practitioners and editors must be cognizant of the limitations of published methodologies. Conclusion. A significant number of articles contained omissions, ambiguity and even errors, which would prevent the methodology being reproduced. The majority of methodologies could be reproduced with the interpretation of an experienced oncology pharmacist, or by utilising resources for detailed literature evaluation.
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