Difficult removal of a wire-reinforced epidural catheter

Pierre, Harold L; Block, Brian M.; Wu, Christopher L.

doi:10.1016/s0952-8180(02)00516-0

Cited by 22 publications

(20 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In general, the approach is to minimize bony structure/soft tissue obstruction to reduce the force required to withdraw the catheter, thereby decreasing the likelihood of catheter breakage. Previous clinical investigations have demonstrated that the flexed position is superior for removal of an entrapped epidural catheter and that 2.5 times as much force is required to remove an epidural catheter in the flexed sitting compared with the flexed lateral position (5,7,18,19). The principle of "placing the patient in the position in which the catheter was inserted" when resistance is encountered during catheter removal is in part derived from these cases and investigations.…”

Section: Discussionmentioning

confidence: 99%

“…Other maneuvers include applying firm, steady pressure, pulling the catheter taut (and taping it to the patient's back or securing it with a tongue depressor to provide gentle traction) and attempting removal hours later, intervening radiologically with passage of a guidewire, and inducing general anesthesia with muscle relaxation (5,18,19). Surgical removal is typically reserved for retrieval of neuraxial catheter fragments that are ferromagnetic, within the intrathecal space, or chronically associated with symptoms of nerve irritation (4,7,20).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Successful Removal of a Knotted Fascia Iliaca Catheter: Principles of Patient Positioning for Peripheral Nerve Catheter Extraction

Offerdahl

Lennon

Horlocker

2004

Anesthesia & Analgesia

View full text Add to dashboard Cite

Peripheral nerve catheters are typically advanced a substantial distance into a perineural sheath, theoretically increasing the risk of catheter knotting and kinking. In this case report, we describe successful removal of a knotted fascia iliaca catheter and discuss principles of nonsurgical catheter extraction. A 64-yr-old woman with bilateral coxarthrosis presented for total hip arthroplasty under combined general/regional anesthesia. A 20-gauge fascia iliaca catheter was inserted before surgery by using a loss-of-resistance "double pop" technique. The catheter was uneventfully advanced 10 cm past the needle tip. After injection of 30 mL of 0.5% bupivacaine with 1:200,000 epinephrine and 100 microg of clonidine, general anesthesia was induced. An infusion of 0.1% bupivacaine at 20 mL/h was initiated in the recovery room for postoperative analgesia. Approximately 48 h later, resistance was encountered during catheter removal. Catheter extraction was attempted by altering patient positioning, including the supine position during which the catheter placement had occurred. Successful catheter removal was achieved by decreasing tension on the fascia lata and fascia iliaca through flexion of the hip joint and by applying firm, steady traction. The catheter was removed intact with a knot approximately 2 cm from the distal tip. We conclude that the principles for removal of entrapped peripheral catheters are not well known and may differ from those for neuraxial catheters. Patient positioning to minimize pressure and tension on the perineural soft tissues may facilitate catheter removal.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successful Removal of a Knotted Fascia Iliaca Catheter: Principles of Patient Positioning for Peripheral Nerve Catheter Extraction

Offerdahl

Lennon

Horlocker

2004

Anesthesia & Analgesia

View full text Add to dashboard Cite

show abstract

“…Pierre et al [9] reported a case in which there was difficulty removing an entrapped epidural catheter in a postpartum woman approximately 7.5 hours after insertion. It was found that cessation of traction for a period of three hours facilitated subsequent easy removal.…”

Section: Methodsmentioning

confidence: 99%

Management of the sheared epidural catheter: is surgical extraction really necessary?

Mitra¹,

Fleischmann²

2007

Journal of Clinical Anesthesia

View full text Add to dashboard Cite

“…An experienced and well-trained person should perform catheter removal without using excessive force or tools, such as forceps (5). Pierre et al (6) observed no problem in the catheters withdrawn approximately 3 h after insertion; however in practice, catheters are not withdrawn at such early times.…”

Section: Discussionmentioning

confidence: 99%

Breakage of an Epidural Catheter Inserted for Labor Analgesia

Üşar¹,

Kar²,

Çıtak³

et al. 2015

Turk J Anaesth Reanim

View full text Add to dashboard Cite

Case Report / Olgu Sunumu Epidural kateter kopması, epidural blok uygulanırken yerleştirme veya çekme sırasında görülebilen, çoğu zaman fark edilemeyen, nadir fakat önemli bir komplikasyondur. Gebe hastamıza analjezi uygulanmak üzere epidural kateter yerleştirilirken, ilerletmede bir sorunla karşılaşılmamasına rağmen yerini tekrar doğrulamak amacıyla kateter geri çekildi ve bu sırada yaklaşık 2 cm kadar distal ucun kopmuş olduğu görüldü. Beyin cerrahi konsültasyonu istendi. Kopan parçanın herhangi bir sorun yaratmayacağı ve doğum analjezisi uygulamak için tekrar girişim yapılabileceği belirtildi. Epidural kateter yeniden takıldı ve doğuma kadar analjezi için sorunsuz bir şekilde kullanıldı. Şu an üzerinden yaklaşık dokuz ay geçmesine rağmen hasta herhangi bir sorun tanımlamadı. Epidural kateter henüz Tuohy iğnesi içindeyken geri çekilecekse olası kopmaları en aza indirilebilmek için mutlaka birlikte çekilmesini öneriyoruz. Görüntüleme ve cerrahi konusunda ise hastanın kliniği-ne göre karar verilebileceği ve takip edilebileceği görüşündeyiz.Anahtar Kelimeler: Epidural analjezi, kateter, komplikasyon, kopmaThe 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.Keywords: Epidural analgesia, catheter, complication, breakage Abstract / Özet

show abstract

Difficult removal of a wire-reinforced epidural catheter

Cited by 22 publications

References 12 publications

Successful Removal of a Knotted Fascia Iliaca Catheter: Principles of Patient Positioning for Peripheral Nerve Catheter Extraction

Successful Removal of a Knotted Fascia Iliaca Catheter: Principles of Patient Positioning for Peripheral Nerve Catheter Extraction

Management of the sheared epidural catheter: is surgical extraction really necessary?

Breakage of an Epidural Catheter Inserted for Labor Analgesia

Contact Info

Product

Resources

About