Subcutaneous Tunneling of Caudal Catheters Reduces the Rate of Bacterial Colonization to That of Lumbar Epidural Catheters

Abstract

Bacterial colonization is regarded as a causative factor for septic complications of caudal catheters in children. To determine whether tunneling caudal catheters reduces the bacterial colonization rate effectively, we evaluated 506 children being treated with tunneled or untunneled caudal or untunneled lumbar epidural catheters. Four-hundred-nine children completed the study. After aseptic removal, the catheters were cultured and sent for microbiological assessment. We found a bacterial colonization rate of 29% in untunneled caudal catheters, 11% in tunneled caudal catheters, and 9% in untunneled lumbar catheters. No severe infectious complications were reported. There was no correlation between catheter retention time and bacterial colonization except for the first 24 h, during which no bacterial colonization was detected. The overall colonization rate remained constant at approximately 13%. We found a positive correlation between bacterial colonization and redness at the catheter entry site. We conclude that tunneled caudal epidural catheters can be used in children for postoperative analgesia without an increased risk of epidural infection.

Infant lumbar and thoracic epidurals for abdominal surgeries: cases in a paediatric tertiary institution

“…As the rate of catheter colonisation by bacteria is higher in caudal catheters, we prefer the thoracic approach to epidural analgesia. (11,12) To the best of our knowledge, there are few studies on epidural analgesia in young children. Earlier studies of neuraxial techniques used on infants arose from a need to avoid general anaesthesia in high-risk groups.…”

Analgesia pós-operatória plexular contínua: estudo dos efeitos colaterais e do risco de infecção dos cateteres

“…No presente estudo não foi encontrado nenhum caso. Wang e col. estimaram a incidência de abcesso peridural em 0,05% e a porcentagem de colonização de cateteres colocados no espaço peridural varia entre 5,8% e 45,8% [25][26][27] . Capdevila e col. e Morin e col. encontraram porcentagens de colonização de 28,7% e 23,5% 16,28 .…”

“…Nerve lesions were not observed in the present study. Wang et al estimated a 0.05% incidence of epidural abscess, and between 5.8 and 45.8% incidence of bacterial colonization of epidural catheters [25][26][27] . Capdevilla et al and Morin et al reported colonization rates of 28.7% and 23.5% 16,28 .…”

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, a total of 22 catheters were found to be colonized by pathogens out of which 14 catheters were taped and 8 were tunneled. Bubeck et al 13 reported a reduced colonization caudal catheters in children if tunneled. No evidence of erythema or bacterial contamination of catheter tip was encountered in our study.…”