Subcutaneous tunnelling of pediatric peripheral nerve block catheters: a novel technique to minimize catheter damage

Sakai, Wataru; Chaki, Tomohiro; Tachibana, Shunsuke; Nawa, Yuko; Yamakage, Michiaki

doi:10.1007/s12630-020-01807-0

Cited by 2 publications

(4 citation statements)

References 3 publications

(3 reference statements)

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“…Our improved technique was described in a previous article, along with a video 6 . In brief, the epidural inner needle is inserted into the tunnel entrance until it emerges from the end of the tunnel.…”

Section: Methodsmentioning

confidence: 99%

“…However, catheter shear and needlestick injuries can occur during epidural tunneling. Although several safer tunneling techniques have been introduced, 2‐6 the optimal technique remains unclear. Although Fujinaka et al explained a tunneling technique for pediatric epidural anesthesia, their technique required mosquito forceps and dilated the hole in the skin 2 .…”

Section: Introductionmentioning

confidence: 99%

“…In our institution, we selected the tunneling technique presented by Balamoutsos et al 4 because their technique was simple and required only an epidural needle to make the epidural tunnel. Recently, we used a tunneling technique published by our team, which requires an epidural needle with a stainless inner needle and an external sleeve of a 20‐gauge IV needle 6 . Pediatric epidural catheters are tiny and can easily break during catheter removal.…”

Section: Introductionmentioning

confidence: 99%

“…Catheter shear is difficult to assess. Our previous preliminary study found that catheter shear could be identified under microscopy, and the degree of catheter shear could be assessed using a tensile apparatus 6 . This new assessment could help objectively determine which tunneling techniques are better and safer with respect to catheter injury.…”

Section: Introductionmentioning

confidence: 99%

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Safety of an improved pediatric epidural tunneling technique for catheter shear

Sakai

Tachibana

Chaki

et al. 2021

Pediatric Anesthesia

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Background Epidural tunneling could help with prolonged catheterization and be effective in preventing infection and dislodgement. However, epidural tunneling techniques carry a risk of catheter shear or needlestick injuries. Aims This study aimed to examine the safety of our epidural tunneling technique in terms of catheter shear. Methods This study was designed as a double‐blinded, single‐crossover, in vitro study. Each of the operators performed two techniques to create a subcutaneous tunnel. We compared outcomes between the control tunneling technique (group C) and our improved technique (group I). Microscopic findings of catheter shear were assessed as the primary outcome. Secondary outcomes included the tension and displacement required to break the epidural catheter and the frequency of catheter breakage due to catheter shear. Data were analyzed using the Fisher's exact test and Mann‐Whitney U test. A p‐value of <.05 was considered statistically significant. Results Ten catheters were assessed in each group. The frequency of catheter shear was 10% in group I and 90% in group C (odds ratio, 0.019; 95% confidence interval [CI], 0.01–0.31; p < .001). The frequency of catheter breakage due to catheter shear was significantly lower in group I (0%) than in group C (80%; p < .001). The mean tension and displacement required to break the catheter were significantly higher in group I than in group C (4.13 ± 0.37 N vs. 3.14 ± 1.00 N; mean difference, 0.99 N; 95% CI, 0.25–1.73 N; p = .013 and 222 ± 59.9 mm vs. 122 ± 77.7 mm; mean difference, 100 mm; 95% CI, 34.1–165 mm; p = .005). Conclusions Our improved epidural tunneling technique, which was designed for pediatric cases, could reduce the risk of catheter shear.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%