Effectiveness of premature epidural catheter termination as a quality indicator in a developing country

Hamid, Mohammad; hoda, Muhammad Qamar ul; Samad, Khalid

doi:10.1097/eja.0b013e328338d56b

Cited by 4 publications

(8 citation statements)

References 18 publications

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“…Previous studies have reported disconnection rates in the range of 1.7-2.3% [4,19,20]; these rates were comparable with the rate in this study's old group, which was 1.9%. In the clinical study, there was a signi cant difference in disconnection rates among the groups; speci cally, these rates were highest in the new group and lowest in the taping group.…”

Section: Discussionsupporting

confidence: 86%

“…Previous studies have reported dislodgement rates in the range of 1.2-5.1% [4,19,20]. The present rates were comparable with or lower than those previously reported, suggesting that this approach may be bene cial.…”

Section: Discussionsupporting

confidence: 83%

“…To the best of our knowledge, this is the rst study examining accidental catheter removal rates and connection strength of epidural catheter connectors since the use of epidural connectors and lters has become the international standard. Several previous studies have investigated accidental removal rates of epidural catheters [4,19,20,23,24]; however, few clinical studies have directly compared epidural connector designs. Doyle et al [13] compared the connection strength of epidural catheter connectors using increment weight as a surrogate measure of linear force.…”

Section: Discussionmentioning

confidence: 99%

“…Epidural analgesia (EA) is effective and helps improve post-surgical morbidity and hospitalization outcomes [1][2][3]. EA is associated with the risk of complications and adverse events, such as accidental epidural catheter removal, including catheter dislodgement and disconnection, post-dural puncture headache, local anesthetic toxicity, and epidural abscess or hematoma formation [4]. Although accidental epidural catheter dislodgement and disconnection are minor complications, they could be associated with the catheter itself rather than patient-or staff-related factors.…”

Section: Introductionmentioning

confidence: 99%

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Accidental Epidural Catheter Removal Rates and Strength Required for Disconnection: a Retrospective Cohort and Experimental Study

Ishida

Homma

Kawamura

et al. 2021

Preprint

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Background: Epidural analgesia requires the use of epidural catheters, which are associated with certain risks such as accidental epidural catheter removal, including dislodgement and disconnection. Few studies have investigated accidental catheter removal rates and directly compared them among epidural connector types. This study aimed to examine the differences in accidental catheter removal rates associated with different catheter connector types and to experimentally determine the linear tensile strength required to induce disconnection in each connector type.Methods: This retrospective cohort study included adult patients who underwent elective surgery and received patient-controlled epidural analgesia between December 2019 and August 2020. Patients were divided into groups according to the type of catheter connection used: standard (old group), new standard (new group), and new standard with taping (taping group). Furthermore, we prepared 60 sets of epidural catheters and connectors comprising 20 sets for each of the old, new, and taping groups, and used the digital tension meter to measure the maximum tensile strength required to induce disconnection. A multinomial logistic regression analysis was used to examine risk factors for disconnection. The experimental study groups were compared using one-way analysis of variance.Results: The clinical study involved in 920 patients (360, 182, and 378 patients in the old, new, and taping group, respectively). Dislodgement rates were similar among the three groups. Disconnection was most likely to occur in the new group (5.5%) and least likely to occur in the taping group (0.3%) compared to the old group (1.9%). However, the new group was not a risk factor for disconnection. The experimental study identified tensile strengths of 12.41 N, 12.06 N, and 19.65 N in the old, new, and taping groups, respectively. Comparison tests showed a significant difference in the tensile strength required for disconnection between the new and taping groups but not between the new and old groups.Conclusions: These findings suggest that taping the catheter connector connection may reduce the risk of disconnection, and thereby help improve patient outcomes. Further studies are required to clarify other parameters that may affect patient safety in this context.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Accidental Epidural Catheter Removal Rates and Strength Required for Disconnection: a Retrospective Cohort and Experimental Study

Ishida

Homma

Kawamura

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Epidural analgesia (EA) is effective and helps improve post-surgical morbidity and hospitalization outcomes [ 1 – 3 ]. EA is associated with the risk of complications and adverse events, such as accidental epidural catheter removal, including catheter dislodgement and disconnection, post-dural puncture headache, local anesthetic toxicity, and epidural abscess or hematoma formation [ 4 ]. Although accidental epidural catheter dislodgement and disconnection are minor complications, they could be associated with the catheter, connector, and filter themselves rather than patient- or staff-related factors [ 5 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Accidental epidural catheter removal rates and strength required for disconnection: a retrospective cohort and laboratory study

et al. 2022

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Background Epidural catheters are associated with certain risks such as accidental epidural catheter removal, including dislodgement and disconnection. Globally, neuraxial connector designs were revised in 2016 to provide new standardization aimed at decreasing the frequency of misconnections during the administration of medications. However, no studies have investigated accidental epidural catheter removal after the revised standardization. This study aimed to examine differences in dislodgement and disconnection rates associated with different catheter connector types, and to investigate the linear tensile strength required to induce disconnection. Methods This retrospective cohort study included adult patients who underwent elective surgery and received patient-controlled epidural analgesia. Patients were divided into groups according to the type of catheter connection used: old standard, new standard, and new standard with taping groups. Furthermore, we prepared 60 sets of epidural catheters and connectors comprising 20 sets for each of the old, new, and taping groups, and used a digital tension meter to measure the maximum tensile strength required to induce disconnection. Results This clinical study involved 360, 182, and 378 patients in the old, new, and taping groups, respectively. Dislodgement rates did not differ statistically among the three groups, while there was a significant difference in disconnection rates. Propensity score matching analysis for disconnection rates showed no difference between the old and new groups (2.8% vs. 4.5%, p = 0.574), while the new group had higher rates than the taping group (6.5% vs. 0%, p = 0.002). This laboratory study identified that a tensile strength of 12.41 N, 12.06 N, and 19.65 N was required for disconnection in the old, new, and taping groups, respectively, and revealed no significant difference between the new and old groups (p = 0.823), but indicated a significant difference between the new and taping groups (p < 0.001). Conclusions This clinical study suggested that dislodgement rates did not change among the three groups. Both clinical and laboratory studies revealed that disconnection rates did not change between the old and new connectors. Moreover, as a strategy to prevent accidents, taping the connecting points of the catheter connectors led to an increase in the tensile strength required for disconnection.

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Influence of protective measures after epidural catheter disconnection on catheter lumen colonization: an in vitro study

Scholle

Kipp

Reich

et al. 2014

Journal of Hospital Infection

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Effectiveness of premature epidural catheter termination as a quality indicator in a developing country

Abstract: Identification of premature epidural catheter termination as a quality indicator and continuous quality improvement efforts later on proved to be a useful approach in reducing the incidence. The present audit also helped to quantify the improvement in the quality of care.

Cited by 4 publications

References 18 publications

Accidental Epidural Catheter Removal Rates and Strength Required for Disconnection: a Retrospective Cohort and Experimental Study

Accidental Epidural Catheter Removal Rates and Strength Required for Disconnection: a Retrospective Cohort and Experimental Study

Accidental epidural catheter removal rates and strength required for disconnection: a retrospective cohort and laboratory study

Influence of protective measures after epidural catheter disconnection on catheter lumen colonization: an in vitro study

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