Factors influencing epidural catheter migration

Abstract

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...

A Prospective, Randomized Study comparing the Efficacy and Safety of Adhesive Strip (Steri-Strips™) Fixation vs Subcutaneous Tunneling for securing Epidural Catheters in Pediatric Patients

“…In their study, out of the 60 migrated catheters only 17 catheters migrated inside by more than 1 cm. Similar findings were also observed by Bishton et al 6 Our study also showed similar results with no epidural catheter migrating inward. In our study, the incidence of migration was more in the Steri-Strips group as compared with the tunneling group.…”

Appropriate length of epidural catheter in the epidural space for postoperative analgesia: evaluation by epidurography

“…This finding is consistent with the result of the study by Bhiston et al who found that the epidural catheter has a tendency to migrate both further into and out of the epidural space after it has been secured. They found that 22% of the catheters migrated more than 1 cm out of the epidural space [13]. Current literature suggests that threading too much of the epidural catheter into the epidural space may direct the catheter right or left, rather than into the middle of the space.…”

Evaluation of a Single-Dose, Extended-Release Epidural Morphine Formulation for Pain After Knee Arthroplasty

“…When DepoDur is injected epidurally, the vesicles slowly erode and reorganize, allowing for the slow and consistent release of morphine to provide pain relief. The DepoFoam drug delivery system may circumvent several of the potential complications associated with indwelling catheters 5,[9][10][11][12][13][14] and may reduce the need for patient-controlled-analgesia pumps.…”