Influence of posture on the incidence of vein cannulation during epidural catheter placement

Abstract

We conclude that there is a direct correlation between the incidence of epidural vein cannulation and patient posture during epidural catheter insertion in parturients.

RETRACTED: Accidental venous and dural puncture during epidural analgesia in obese parturients (BMI > 40 kg/m2): three different body positions during insertion

“…Although an epidural catheter that has been accidentally placed intravascularly may be identified and repositioned, it also may go undetected [2][3][4]. The increase in inferior vena cava (IVC) pressure may be the predisposing factor for this complication [5,6].…”

“…The preference for patient position during the procedure is variable [16][17][18][19][20][21][22]. In previous studies in non-obese parturients [2,23], a direct correlation was shown between the incidence of epidural vein cannulation and patient position at insertion, with a higher incidence noted in the sitting position, 10.7% versus 6% [23], and 15.7% versus 3.7% [2]. In morbidly obese [body mass index (BMI) 35-39.9 kg/m 2 ] parturients [24], placing the patients in the lateral recumbent head-down position reduced the frequency of epidural venous puncture from 10.7% to 2% and from 12% to 1.3%, respectively.…”

Effects of epinephrine in the epidural space on the incidence of blood vessel injury by epidural catheter insertion for cesarean section: a prospective, randomized, double-blind study

“…There are extensive vascular plexuses in the epidural space which may be punctured during epidural puncture [1][2][3][4], especially in parturients. Occasionally, blood vessel injuries occur during epidural catheter insertion [5][6][7].…”

“…Occasionally, blood vessel injuries occur during epidural catheter insertion [5][6][7]. The incidence of injuries involving the epidural venous plexus on intravascular (IV) epidural catheter insertion was between 1.3% and 15.7% for obstetric patients; the incidence was higher when the puncture is performed with the patients in the sitting position [2]. Furthermore, inadvertent epidural venous injuries may lead to local anesthetic-induced cardio-or neurotoxicity, a poor anesthetic effect, and even the occurrence of epidural hematomas [8][9][10].…”

Neuraxial techniques for labor analgesia should be placed in the lateral position

“…These epidural plexus changes related to positioning are relevant to the success of neuraxial techniques. When Harney et al 21 randomized 209 parturients to the lateral or sitting position for epidural placement, blood was observed in the catheter 3.7% and 7% of the time, respectively. Similarly Bahar et al 22 , randomizing 900 women to the lateral and lateral Trendelenburg (LT) versus sitting positions, observed lower epidural venous punctures in the lateral and LT positions than in the sitting position ( Table 1).…”