Subarachnoid lumbar drains: A case series of fractured catheters and a near miss

Abstract

Purpose: Lumbar subarachnoid catheters for cerebrospinal fluid (CSF) drainage (lumbar drains) are indicated for several medical and surgical conditions. A number of complications can occur from the placement of this type of catheter, including catheter breakage from excessive traction or shearing over the Tuohy needle. Clinical features:Five cases of lumbar subarachnoid catheter breakage/shearing and catheter fragment retention, as well as one near miss, were identified over a one-year period at a single institution. All (n = 6) patients were undergoing neurosurgical procedures. Four patients required surgical retrieval of the catheter fragments. No patient experienced log-term neurological sequelae.Discussion: From these experiences, the following risks factors for catheter rupture are identified: 1) intentional or accidental retraction of the catheter through the needle during placement; 2) faulty use of the guidewire; or 3) use of excessive force during removal of the catheter. Methods to prevent such complications are suggested, including minimal use, or complete avoidance of a guidewire.

Assessing risk/benefit of lumbar drain use for endoscopic skull‐base surgery

“…18 Obviously, with severe pain or neurological deficits, operative removal of the retained fragment is indicated-adding both significant morbidity and resource utilization. 19 In our patient, removal of the catheter pieces was accomplished at the time of the endoscopic procedure, thus avoiding an additional anesthetic. A follow-up CT of the lumbar spine was ordered to confirm complete retrieval.…”

Paraparesis after Lumbar Drain Placement and Catheter Tear: A Rare Case Report

“…2,3 Catheter shearing and retained intrathecal fragment are either underreported or rare with an incidence rate of 0 to 3.3%. 4,5 Most cases of retained intrathecal catheter fragments are associated with difficulty while inserting or advancing the catheter into the subarachnoid space. A catheter may be broken by excessive force or stretching, sheared by the sharp edge of Tuohy needle or due to incorrect use of the guidewire.…”

“…10 We used an External CSF Drainage System (G. Surgiwear Ltd., Shahjahanpur, India) that contains a 14G Tuohy needle (9 cm) and 30-cm lumbar drainage catheter (0.7 mm internal diameter, 1.5 mm outer diameter). The intrathecal siliconized catheter is larger and softer than an epidural catheter to minimize damage to the spinal cord or nerve roots, 4 but it can make the advancement of the catheter through the Tuohy needle (which has a sharp-edged tip) difficult.…”

“…A neurophysician was consulted, and 1 g methylprednisolone was administered intravenously. An urgent magnetic resonance imaging (MRI) revealed a residual tumor in the posterior fossa and myelitis involving the dorsal (D [3][4][5][6][7][8] ) cord (►Fig. 1) and conus (►Fig.…”

Perioperative Cerebrospinal Fluid Diversion Utilizing Lumbar Drains in Transsphenoidal Surgery

“…Conservative management and observation is indicated unless the fragment results in pain or neurological deficits [26]. The resulting operation for removal adds significantly to morbidity and resource utilization [39]. Often, follow up imaging of the lumbar spine is ordered to corroborate complete removal.…”