Retained epidural catheter: A rare complication. Report of two cases

Molina-García, Rodrigo A.; Muñoz-Martínez, Ana Catalina; Hoyos-Pescador, Roxanna; Torre-Espinosa, Ramón De la

doi:10.1016/j.rcae.2016.02.009

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…Faulty design, faulty insertion or withdrawal technique, and entrapment by bony or ligamentous tissues during removal have been associated with epidural catheter breakage [ 1 ]. García et al [ 2 ] reported the presence of a knot at the tip of the catheter preventing withdrawal was the reason for breakage. Other reported causes include Nikhilesh et al [ 3 ] multiple attempts; Reena and Vikram [ 4 ] excessive length of the catheter has been inserted.…”

Section: Discussionmentioning

confidence: 99%

When The Unexpected Happens: The Intriguing Retrieval of a Broken Epidural Catheter

Dussa,

Kokate

et al. 2024

jocr

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Introduction: The accidental breakage of an epidural catheter during placement or removal poses a rare but challenging situation in clinical practice. This case report presents the successful removal of a broken epidural catheter and highlights the management strategies employed. Case Report: A 41-year-old male patient underwent a planned orthopedic implant removal surgery under epidural anesthesia. During catheter removal, a portion of the catheter fractured and remained lodged within the epidural space. The patient experienced persistent pain and concern regarding the retained fragment, necessitating immediate intervention. A multidisciplinary team comprising an orthopedic surgeon, neurosurgeon, anesthesiologist, and radiologists collaborated to develop a tailored retrieval strategy. Magnetic resonance imaging aided in localizing the fractured catheter fragment. Using a standard midline posterior approach, the catheter was safely removed without any complications. Post-retrieval monitoring revealed no adverse events, and the patient reported resolution of pain and improved satisfaction. Conclusion: Retrieving a broken epidural catheter requires a systematic and individualized approach. This case report contributes to the existing literature by providing insights into managing this rare complication, highlighting the importance of a multidisciplinary team, appropriate imaging, and meticulous retrieval techniques to ensure patient safety and optimal outcomes. Keywords: Epidural catheter, spine surgery, broken catheter, explorative laminectomy.

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Section: Discussionmentioning

confidence: 99%

When The Unexpected Happens: The Intriguing Retrieval of a Broken Epidural Catheter

Dussa,

Kokate

et al. 2024

jocr

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“…In our review, 64.4% of epidural placements were at the lumbar region, and only 5 cases reported placement above the lumbar region, which is consistent with the high incidence of obstetric cases in our study population. Most knotted catheters are inserted at the lumbar level, especially in obstetric patients, and a knot is formed along the last 3 cm of the catheter [ 7 ]. Muneyuki et al [ 8 ] reported that an indwelling thoracic epidural catheter was less likely to curl, bend, or kink in the epidural space than an indwelling lumbar epidural catheter, and a greater amount of the catheter could be inserted without coiling, which attributes to the difference in the angle of insertion of the needle.…”

Section: Discussionmentioning

confidence: 99%

Removing knotted or stuck epidural catheters: a systematic review of case reports

et al. 2023

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Background: The knotting or in vivo entrapment of epidural catheters is an uncommon but challenging issue for anesthesiologists. This study aimed to identify the possible causes behind entrapped epidural catheters and the effective methods for their removal. Methods: A systematic review of relevant case reports and series was conducted using the Patient/population, intervention, comparison and outcome (PICO) framework and keywords such as “epidural,” “catheter,” “knotting,” “stuck,” “entrapped,” and “entrapment.” The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed, and the review was registered with International Prospective Register for Systematic Reviews (PROSPERO) (CRD42021291266). Results: The analysis included 59 cases with a mean depth of catheter insertion from the skin of 11.825 cm and an average duration of 8.17 h for the detection of non-functioning catheters. In 27 cases (45.8%), a radiological knot was found, with an average length of 2.59 cm from the tip. The chi-squared test revealed a significant difference between the initial and final positions of catheter insertion (P = 0.049).Conclusions: Deep insertion was the primary cause of epidural catheter entrapment. To remove the entrapped catheters, the lateral decubitus position should be attempted first, followed by the position used during insertion. Based on these findings, recommendations for the prevention and removal of entrapped catheters have been formulated.

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“…From our review, 15 (41.6%) catheters were retained during removal, [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] and 8 (22.2%) catheters could not be removed due to knotting. [17][18][19][20][21][22][23] Knotted catheters mostly involved excessive lengths threaded during insertion ranging 4 to 17 cm with a median length of 7 cm. We found 5 (13.8%) cases whereby a fragment was sheared off as a result of being cut by the Touhy needle as it was withdrawn through it [24][25][26][27][28] and 4 (11.1%) cases of fragments fracturing from excessive force during extraction together with the Touhy needle.…”

Section: Potential Mechanisms and Risk Factorsmentioning

confidence: 99%

“…Exposed catheter fragment acting as fistula/ channel [17][18][19][20][21][22][23] Symptomatic fragment 5,26,28,34 Retained length > 5 cm Intrathecal migration Patient preference…”

Section: Surgical Removal Conservative Treatmentmentioning

confidence: 99%

Retained epidural catheter: an update

Tan,

Balashanmugam,

Ahmad Shah

et al. 2023

MYJA

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The retained catheter fragment is a rare complication when performing epidural techniques. There is a paucity of studies available, with Australian data quoting an incidence of 1 in 60,000. For this article, we reviewed 36 case reports of retained epidural catheters between 1995 and 2020. The case reports found computed tomography scans to be the most reliable modality to investigate a retained epidural catheter. The decision to surgically remove or treat conservatively should be multidisciplinary with most operations involving symptomatic or long fragments. In our review, we found 25 (69.4%) reports of surgical removal, with 21 opting for immediate removal. Conservatively treated retained fragments should be monitored for neurological or infective complications. Patients should receive a follow-up plan and be educated regarding red flag symptoms to facilitate further management. For future reference, a detailed documentation of the incident, parties involved, discussions, and decisions should be made.

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Retained epidural catheter: A rare complication. Report of two cases

Cited by 4 publications

References 10 publications

When The Unexpected Happens: The Intriguing Retrieval of a Broken Epidural Catheter

When The Unexpected Happens: The Intriguing Retrieval of a Broken Epidural Catheter

Removing knotted or stuck epidural catheters: a systematic review of case reports

Retained epidural catheter: an update

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