A systematic review of the diagnostic accuracy of epidural wave form analysis to identify the epidural space in surgical and labor patients

Hilber, N.; Rijs, K.; Klimek, Markus; Saenz, Guillermo; Aloweidi, Abdelkarim; Rossaint, Rolf

doi:10.23736/s0375-9393.18.13089-6

Cited by 8 publications

(6 citation statements)

References 28 publications

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“…The visual interpretation is dependent upon a clinician’s subjective identification of a waveform on the screen. 3 Visualization of a peak-to-peak (apex-to-apex) frequency, synchronous with that of the cardiovascular pulse rate periodicity, is consistently observed across all affirmative pulsatile pathways, while the height of the waveform amplitude is found to vary between different waveforms. It is noted that the height of the waveform amplitude is dependent on the oscilloscope setting of the vertical scale with respect to ±mm/Hg.…”

Section: Discussionmentioning

confidence: 89%

“…Regarding technical aspects, as opposed to the pressure transducers used in the previous studies, 3 the CCDDS technology, utilizing a high-resolution pressure in-line sensor system, was capable of detecting the presence of a pulsatile waveform, when present, with a high degree of sensitivity. Previous research conducted in detecting a pulsatile waveform was based upon visual inspection of a sine-wave on a medical oscilloscope display.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 The occurrence of these pulsatile waveforms in synchrony with heart rate, obtained by transducing the epidural catheter, has been reported to be a sign confirming the epidural location of the catheter. 3 The use of customary invasive blood pressure monitors and pressure transducers may, however, be problematical in labor and delivery setting, and, in all cases, they may also be considered to be an “off-label” resource, since not specifically designed for this purpose.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Epidural Waveform to Determine Correct Epidural Catheter Placement After CSE Labor Analgesia

Coccoluto¹,

Capogna²,

Camorcia³

et al. 2021

LRA

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Background The epidural pressure is pulsatile and synchronized with arterial pulsations. Monitoring the epidural waveform has been suggested as a technique to reliably confirm the appropriate localization of the epidural catheter. Objective The aim of this study was to evaluate the sensitivity and specificity of the Computer Controlled Drug Delivery System with continuous pressure and waveform sensing technology (CCDDS) (CompuFlo ® CathCheck™) as an instrument to assess the correct placement of the catheter in the epidural space in parturients who have received combined spinal-epidural technique (CSE) for labor analgesia. Methods We enrolled 40 consecutive healthy patients undergoing CSE labor analgesia with successful analgesia. All the cases in which pulsatile waveforms in synchrony with heart rate were detected were considered to be true positives; all the cases in which there was the absence of pulsatile waves were followed up. If these patients had to eventually relocate or manipulate the epidural catheter, they were considered to be true negative. If the absence of pulse waves was observed in the presence of successful analgesia during labor, the patients were considered to be false negatives. Results Pulsatile waveforms synchronous with heart rate were observed in 33 cases associated with adequate analgesia. In 5 cases, the pulsatile waveforms were absent due to unilateral analgesia or catheter occlusion (true negatives). In 2 cases, the patients had effective analgesia but we were not able to observe a distinct pulsatile waveform. The pressure waveform analysis through the epidural catheter had a sensitivity of 95%, a positive predictive value of 100%, a specificity of 100% and a negative predictive value of 60%. Conclusion Pulsatile pressure waveform recording with CCDDS through the epidural catheter resulted in high sensitivity and positive predictive value which can help the proper placement of the epidural catheter.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Analysis of Epidural Waveform to Determine Correct Epidural Catheter Placement After CSE Labor Analgesia

Coccoluto¹,

Capogna²,

Camorcia³

et al. 2021

LRA

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“…in a systematic review published in the same month, Hilber et al reviewed the literature on this technique and concluded that the analysis of the epidural waveform is also useful to identify the epidural space both in labor and surgical patients. 66 anesthetists often use color Doppler images to detect vascular structures during peripheral nerve blocks. Bereket et al proposed a new application of color Doppler imaging.…”

Section: Regional Anesthesiamentioning

confidence: 99%

A year in review in Minerva Anestesiologica 2019. Anesthesia, analgesia, and perioperative medicine

Cavaliere

Allegri²,

Apan

et al. 2020

Minerva Anestesiol

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“…The presence of pulsatile waveforms have been well documented in cervical [5], thoracic [6] [7] [8] [9] [10] and lumbar epidural space, [8] [11] and high sensitivity to reliably identify the epidural space and correct epidural positioning of needle and catheter has been reported in many studies [12].…”

Section: Introductionmentioning

confidence: 99%

Confirmation of Epidural Catheter Location by Epidural Pressure Waveform Recordings by the Compuflo<sup>&reg; </sup> Cath-Checker System

Capogna¹,

Camorcia²,

Berritta³

et al. 2020

OJAnes

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Background: Pulsatile waveforms originating from the spinal cord and transmitted through the dura in synchrony with heart rate have been used to confirm the epidural location of the catheter. Lumbar epidural space identification using the CompuFlo ® instrument has been reported and validated. The aim of this preliminary study was to evaluate the new CompuFlo instrument which allows the identification of pulsatile waveform recordings. Methods: We tested 30 epidural catheters previously successfully used for post cesarean analgesia and about to be removed. All patients were given 5 mL 2% lidocaine to test the catheter before its removal. After priming with 5 mL saline, the catheter was connected to CompuFlo ® to record the occurrence of pulsatile waveforms and/or their disappearance during its removal. Results: Pulsatile waveforms were observed in all the catheters properly located in the epidural space and disappeared when the catheter was extracted from the epidural space. No waveforms were recorded in 2 cases in which no sensory block occurred after the test dose (catheter dislodgement). The pressure waveform analysis through the epidural catheter had a sensitivity of 100%, a positive predictive value of 100%, a specificity of 100% and a negative predictive value of 100%. Conclusions: In this preliminary trial pulsatile pressure waveform recording with CompuFlo ® CathCheck™ System through the epidural catheter resulted in high sensitivity and positive predictive value.

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A systematic review of the diagnostic accuracy of epidural wave form analysis to identify the epidural space in surgical and labor patients

Cited by 8 publications

References 28 publications

Analysis of Epidural Waveform to Determine Correct Epidural Catheter Placement After CSE Labor Analgesia

Analysis of Epidural Waveform to Determine Correct Epidural Catheter Placement After CSE Labor Analgesia

A year in review in Minerva Anestesiologica 2019. Anesthesia, analgesia, and perioperative medicine

Confirmation of Epidural Catheter Location by Epidural Pressure Waveform Recordings by the Compuflo<sup>&reg; </sup> Cath-Checker System

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A systematic review of the diagnostic accuracy of epidural wave form analysis to identify the epidural space in surgical and labor patients

Cited by 8 publications

References 28 publications

Analysis of Epidural Waveform to Determine Correct Epidural Catheter Placement After CSE Labor Analgesia

Analysis of Epidural Waveform to Determine Correct Epidural Catheter Placement After CSE Labor Analgesia

A year in review in Minerva Anestesiologica 2019. Anesthesia, analgesia, and perioperative medicine

Confirmation of Epidural Catheter Location by Epidural Pressure Waveform Recordings by the Compuflo&lt;sup&gt;&amp;reg; &lt;/sup&gt; Cath-Checker System

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Confirmation of Epidural Catheter Location by Epidural Pressure Waveform Recordings by the Compuflo<sup>® </sup> Cath-Checker System