On knots in epidural catheters: a case report and a review of the literature

Brichant, Jean-François; Bonhomme, Vincent; Hans, Pol

doi:10.1016/j.ijoa.2005.07.003

Cited by 32 publications

(32 citation statements)

References 28 publications

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“…Some reports described single cases in samples of over 20,000–30,000 [5–7]. Most of the reported cases were related to obstetric epidural analgesia and/or anesthesia [8]. Therefore, cases of knotting have been reported primarily in lumbar epidural catheters, with only one case involving a thoracic epidural catheter [9].…”

Section: Discussionmentioning

confidence: 99%

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Knotting of a Cervical Epidural Catheter in the Patient with Post-Herpetic Neuralgia: A Rare Complication

2017

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Epidural block is achieved either by single injection of local anesthetic through an epidural needle or as a continuous block by infusion pump through an epidural catheter. Complications associated with epidural catheters include breakage, entrapment, and knotting. Knotting of epidural catheters is very rare, but knotting in lumbar epidural catheters has been reported in a number of studies, and most of these cases involved removal difficulty. We report a case in which we inserted a cervical epidural catheter in a patient who was experiencing severe post-herpetic neuralgia and then removed the knotted catheter without complications.

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Section: Discussionmentioning

confidence: 99%

“…The optimal length of insertion, however, remains controversial. It has been recommended that the length of catheter insertion not exceed 5 cm, and less than 3–4 cm is considered optimal to prevent knotting [8,10]. However, knots in epidural catheters have been reported even when no more than 3 cm had passed in the epidural space.…”

Section: Discussionmentioning

confidence: 99%

Knotting of a Cervical Epidural Catheter in the Patient with Post-Herpetic Neuralgia: A Rare Complication

2017

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“…No side effects or complications were observed until the In most cases, knots of the epidural catheter are formed when the catheter is deeply inserted into the epidural space (at least 6 ㎝), so that it is curved, twisted, bent, or it is turned in the opposite direction 2,8 of its insertion. [2][3][4]9 Generally, knots are formed when deeply inserting a catheter into the epidural space [5][6][7]9 or upon its removal after deeply inserting it into the epidural space. [2][3][4] However, knots are also formed when the catheter is mounted less than 3 ㎝ inside the epidural space.…”

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confidence: 99%

“…[2][3][4]9 Generally, knots are formed when deeply inserting a catheter into the epidural space [5][6][7]9 or upon its removal after deeply inserting it into the epidural space. [2][3][4] However, knots are also formed when the catheter is mounted less than 3 ㎝ inside the epidural space. 6 In this case, unlike previously reported cases, the resistance occurred when inserting the epidural catheter after finding the epidural space with loss of resistance keeps the catheter from be major cardiovascular issues such as cardiac death, stent thrombosis, and myocardial infarction.…”

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confidence: 99%

Knot Formation at Removal of an Epidural Catheter Placed Against Insertion Resistance Encountered at the Entrance of the Epidural Space

Kil

Kim

2016

KMJ

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Knots formed when inserting a catheter for epidural anesthesia have an incidence rate of 0.0015%, which is extremely rare. Knotting of an epidural catheter occurs very rarely with an estimated incidence of 0.0015%. We present a case of an epidural catheter knot formed at removal of an epidural catheter following a forceful insertion of the catheter against resistance met at the entrance of the epidural space during threading of the catheter through Tuohy needle placed uneventfully in a 65 year-old male patient undergoing epidural anesthesia. During removal of the epidural catheter, significant resistance was encountered on traction and it was found that approximately 1.5 ㎝ portion of the catheter had been retained within the patient's subcutaneous tissue. Firm traction was employed to withdraw the catheter against the resistance. The catheter was pulled out uneventfully from the patient. A knot estimated to be formed during removal of the catheter was observed at 0.6 ㎝ proximal to the catheter tip. No complications and side effects were noted until the patient's discharge.

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“…We recommend threading the catheter no more than 5 cm into the epidural space [1,3]. The cardiac syndrome takotsubo cardiomyopathy (TTC) was first described by Sato et al [1] in 1990, and for a decade after this first report, cases of TTC were reported only inside Japan [1][2][3][4]. Because of these limited reports, TTC was initially recognized as a specific cardiac disorder in the Japanese population.…”

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confidence: 99%