Relationship Between the Bevel of the Tuohy Needle and Catheter Direction in Thoracic Epidural Anesthesia

Choi, Duck Hwan; Lee, Sangmin M.; Cho, Hyun Sung; Ahn, Hyun Joo

doi:10.1016/j.rapm.2005.11.015

Cited by 8 publications

(3 citation statements)

References 12 publications

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“…While previous investigations have suggested that the majority of thoracic epidural catheters placed with the bevel of the Tuohy needle facing cephalad will thread in the cephalad direction, catheters have been shown to thread laterally, to curl within the epidural space, or to even redirect caudally, which our study corroborates. 12 As a result, clinicians must appreciate that the ability to predict the final catheter tip location is inexact.…”

Section: Discussionmentioning

confidence: 99%

Surface Landmarks in the Lateral Decubitus Position Are Unreliable for Thoracic Epidural Catheter Placement: A Case Series

Dobson¹,

Weller²,

Turner³

et al. 2022

A&A Practice

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Thoracic epidurals remain the optimal method for providing postoperative analgesia after complex open abdominal and thoracic surgeries. However, they can be challenging to both place and maintain, as evidenced by a failure rate that exceeds 30%. 1 Proper identification of the epidural space and accurate placement of the catheter are critical in order to deliver effective postoperative analgesia and avoid failure. 2,3 This case series investigated the difficulty in correctly identifying the proper vertebral level for thoracic epidural catheter procedures when performed in the lateral decubitus position.

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Section: Discussionmentioning

confidence: 99%

Surface Landmarks in the Lateral Decubitus Position Are Unreliable for Thoracic Epidural Catheter Placement: A Case Series

Dobson¹,

Weller²,

Turner³

et al. 2022

A&A Practice

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“…In Japan, it is also reported that a similar analgesic effect is achieved after surgery when catheterization is performed by either residents (in the late stage of their postgraduate clinical training) or specialists, and that patients are unlikely to experience any disadvantage related to the experience level of the treating anesthesiologist [ 28 ]. Regarding the approach to the epidural space, it is generally considered that the paramedian technique facilitates the advance of the catheter toward the head, allows a longer part of the catheter to be placed within the target site, and causes fewer incidents of deviation into the paraspinal space, compared to the median technique [ 29 – 31 ]. However, no significant difference was observed in our study.…”

Section: Discussionmentioning

confidence: 99%

Lateral deviation of four types of epidural catheters from the lumbar epidural space into the intervertebral foramen

et al. 2016

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BackgroundDuring epidural anesthesia, the catheter tip occasionally deviates from the epidural space into the intervertebral foramen, resulting in inadequate anesthesia.MethodsDuring postoperative plain radiography, iohexol was injected via the epidural catheter to determine its position and to observe the spread of the material. After exclusion of seven patients with catheters that migrated into the subcutaneous area and 25 patients with no evidence of the contrast medium, 415 patients were evaluated. We retrospectively compared patients to determine whether the incidence of deviation into the intervertebral foramen differed between four types of epidural catheters. We also investigated the load applied to the catheter tip using a Shimadzu Autograph AG-X-500 N-111 universal testing machine.ResultsDeviation of the epidural catheter into the intervertebral foramen was observed in eight and 33 patients in the Hakko and Perifix Soft tip catheter groups, respectively. The incidence of deviation was higher in the Perifix Soft tip catheter group, and lower in the FlexTip Plus and Perifix FX catheter groups. A rapid increase was observed in the force exerted on the tips of the Hakko and Perifix Soft tip catheters, while the force transmitted to the tips of the FlexTip Plus and Perifix FX catheters gradually increased and then reached a plateau at a low level.ConclusionsThe incidence of deviation was significantly lower with spiral-type catheters than with other types of catheters. This might be attributable to the gradual transmission of a lower level of force to the tip in spiral-type catheters.

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“…7Y17 This mechanical issue cannot be entirely prevented by following good technical practices: curling at the distal tip occurred in 17.6% of the thoracic epidural catheters placed in 1 study, regardless of the direction of the Tuohy needle bevel. 18 Other studies have shown that limiting the length of catheter inserted into the epidural space to less than 3 to 5 cm may help avoid knotting and kinking. 2,11,16,17 Once the catheter is properly inserted, locating the tip in the epidural space continues to be a challenge.…”

Section: Discussionmentioning

confidence: 99%

Near-Infrared Tracking System for Epidural Catheter Placement

Chiu

Bristow

2012

Regional Anesthesia and Pain Medicine

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Relationship Between the Bevel of the Tuohy Needle and Catheter Direction in Thoracic Epidural Anesthesia

Abstract: The correlation between bevel direction and location of the thoracic epidural catheter was relatively low. Practices such as threading an epidural catheter by manipulation of the Tuohy needle for the control of pain at a distant site may not yield good results.

Cited by 8 publications

References 12 publications

Surface Landmarks in the Lateral Decubitus Position Are Unreliable for Thoracic Epidural Catheter Placement: A Case Series

Surface Landmarks in the Lateral Decubitus Position Are Unreliable for Thoracic Epidural Catheter Placement: A Case Series

Lateral deviation of four types of epidural catheters from the lumbar epidural space into the intervertebral foramen

Near-Infrared Tracking System for Epidural Catheter Placement

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