Quebra de cateteres peridurais: etiologia, prevenção e conduta

Abstract

The catheter should not be inserted more than five centimeters into de epidural space. Exploratory laminectomy should be undertaken if the patient develops signs or symptoms of neurologic changes, if the catheter is inside the subarachnoid space, or whenever the tip of the catheter is emerging out of the skin. Due to the difficulty to localize retained fragments by imaging exams, catheters should be manufactured with materials that improve their visualization.

Successful management of a broken epidural catheter!!!

“…The reason may be small thickness of the epidural catheter and the fact that surrounding tissue is highly radiodense,[4] so catheters should be manufactured with materials that improve their visualization. [2] In accordance with the data, we also could not appreciate the catheter in digital X-ray and only a small fragment (2–3 cm) was seen on CT plates.…”

“…The patient must be assured that occurrence of neurological sequel is rare and must be informed about treatment options available in such cases. [24]…”

“…[27] The other possible options being (a) leaving a retained epidural catheter in place in adult patients, (b) providing patient education regarding “red flags” to watch out for, and (c) consultation of neurosurgeons for cases of sheared catheter. [17]…”

“…[1] However, a range of complications including abscess, spinal hematoma, radiculopathy, breakage, migration, kinking, and knotting can occur as the catheter is inserted into the epidural space. [23] Although an epidural catheter is normally removed without complications, the catheter can break under conditions such as the impact on the catheter during insertion or removal. [3] For the period between 1957 and the present date, 15 articles reporting thirty cases of epidural catheter breakage were identified.…”

“…[3] For the period between 1957 and the present date, 15 articles reporting thirty cases of epidural catheter breakage were identified. [2] Due to the small number of cases found in the literature, it is controversial to decide whether to leave or remove indwelling catheter fragments. We report a successful surgical extraction of an epidural catheter which broke during a prior attempt to remove it by hand, along with a review of available literature regarding the prevention, management, and removal of a broken epidural catheter.…”