Epidural catheters of the multi‐orifice type: dangers and complications

Abstract

A study on epidural catheters of the multi-orifice type, investigating their tendency to epidurovasal (with an intravascularly positioned catheter tip) and epidurosubarachnoid (with the catheter tip inserted in the subarachnoid space) malpositioning, was conducted on 113 patients using clinical and radiological criteria as controls. Of the improperly placed catheters, 13 were in an epidurovasal (11.5%) and one was in an epidurosubarachnoid (0.9%) position. The findings demonstrate the occasional hazardous dual compartmental misplacement of multi-orifice catheters, in which a distal opening can lie intravascularly or within the subarachnoid space, while a proximal orifice simultaneously retains normal access to the epidural space. The insufficiency of controlling or even recognizing such improperly placed catheters which are only partially in the epidural space, as well as the danger of causing a secondary dural or vascular perforation with epidural catheters, is discussed. Since epidural catheters of the multi-orifice type apparently represent an inherent, vital danger due to their construction (regardless of the catheter material and workmanship), they should no longer be used.

Insertion length and resistance during advancing of epidural catheter

“…Nevertheless it is wise to keep in mind the occasional hazardous dualcompartmental misplacement of multiorifi ce catheters, in which a distal opening can lie intravascular or within the subarachnoid space, while the proximal orifi ce simultaneously retains normal access to the epidural space. Administration of a test dose and a 5-min interval before performing the epidural injection should help to identify such catheter misplacement [14]. In our study, on removal of the epidural catheter, a distal (primary) bend was noted at a mean length of 2.4 ± 1.3 cm; this was similar to that reported by Lim et al [11].…”

Lumbar epidurography with multi‐orifice and single orifice epidural catheters

“…Whereas practice in the United States of America favours catheters with a single end hole, multi-orifice catheters are predominantly used in the UK [3]. Although multi-orifice catheters may be less safe because they can be sited partially subdurally and allow multi-compartmental spread of local anaesthetic [4, 51, they are less likely to occlude and require resiting.…”

Variations in epidural catheter manufacture: Implications for bending and stiffness

“…13 Case reports document delayed subdural 14,15 and subarachnoid 16 catheter migration. Burstal et al 2 reported 3 occurrences of intravenous catheter migration and 1 occurrence of subarachnoid catheter migration in 1,291 continuous epidurals.…”