Evaluation of epidural catheter tip position

Background If the epidural spread of contrast medium can be well correlated with the spread of local anesthetics, epidurography can predict the dermatomal distribution of the anesthetic block. The authors evaluated the relation between radiographic and analgesic spread. Methods An epidural catheter was inserted in 90 patients, and predicted catheter tip position was recorded. The analgesic area was determined by pinprick after a 5-ml injection of 1.5% lidocaine, and epidurography was performed after a 5-ml injection of 240 mg I/ml iotrolan. Patients were assigned to three groups according to catheter tip position (group C: C-T4; group T: T5-T10; group L: T11-L), and patterns of spread were compared. In 16 of 90 subjects, radiographic and analgesic spread was further investigated after an additional 5-ml injection of iotrolan and lidocaine. Results The total radiographic spread correlated well with analgesic spread (right side: Y = 0.84 X + 0.16, r = 0.92, P < 0.01; left side: Y = 0.78 X + 0.45, r = 0.91, P < 0.01). The mean radiographic spread in the cephalad and caudal directions from the catheter tip also correlated well with mean analgesic spread (r = 0.97, P < 0.01, each direction). The mean distance between the predicted catheter tip and radiographically determined positions was 1.0 +/- 0.8 segments: the value in group T was significantly larger than that in groups C (P < 0.05) and L (P < 0.01). Although the correlation of radiographic spread with age was statistically significantly (r = 0.39, P < 0.01), great individual variation in spreading pattern was seen. In 16 subjects, mean radiographic spread correlated well with analgesic spread after 5- and 10-ml injections of iotrolan and lidocaine. Conclusions Epidurography is useful to indicate epidural catheter position and can help to predict the exact dermatomal distribution of analgesic block.

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Influence of Catheter Tip Position on Pulmonary Wedge Pressures

Circulation Research ◽

10.1161/01.res.10.2.215 ◽

1962 ◽

Vol 10 (2) ◽

pp. 215-219 ◽

Cited By ~ 5

Author(s):

A. L. Loomis Bell ◽

William F. Haynes ◽

Seiichi Shimomura ◽

Donald P. Dallas

Keyword(s):

Catheter Tip ◽

Tip Position

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Peroperative intravasal electrographic control of catheter tip position in access ports placed by venous cut-down technique

European Journal of Surgical Oncology ◽

10.1053/ejso.2000.1047 ◽

2001 ◽

Vol 27 (3) ◽

pp. 316-320 ◽

Cited By ~ 12

Author(s):

M. Stas ◽

S. Mulier ◽

P. Pattyn ◽

J. Vijgen ◽

I. De Wever

Keyword(s):

Catheter Tip ◽

Tip Position

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Precision in Central Venous Catheter Tip Placement: A Review of the Literature

Journal of the Association for Vascular Access ◽

10.2309/java.15-3-3 ◽

2010 ◽

Vol 15 (3) ◽

pp. 112-125 ◽

Cited By ~ 21

Author(s):

Russell Hostetter ◽

Nadine Nakasawa ◽

Kim Tompkins ◽

Bradley Hill

Keyword(s):

Central Venous Catheter ◽

Selection Criteria ◽

Weighted Average ◽

Venous Catheter ◽

Central Venous ◽

Catheter Tip ◽

Tip Position ◽

Landmark Technique ◽

The Ideal

Abstract Background: Long term venous catheters have been used to deliver specialized therapies since 1968. The ideal tip position of a central venous catheter provides reliable venous access with optimal therapeutic delivery, while minimizing short-and long-term complications. Ideal position limits have evolved and narrowed over time, making successful placement difficult and unreliable when depending exclusively on the landmark technique. Objective: To review and analyze contemporary literature and calculate an overall accuracy rate for first attempt placement of a PICC catheter in the ideal tip position. Methods: Key PICC placement terms were used to search the database PubMED-indexed for MEDLINE in June and October, 2009. The selection of studies required: a patient cohort without tip placement guidance technology; a documented landmark technique to place catheter tips; data documenting initial catheter placement and, that the lower third of the SVC and the cavo-atrial junction (CAJ) were included in the placement criteria. With few exceptions, articles written between 1993 and 2009 met the stated selection criteria. A composite of outcomes associated with tip placement was analyzed, and an overall percent proficiency of accurate catheter tip placement calculated. Results: Nine studies in eight articles met the selection criteria and were included for analysis. Rates of first placement success per study ranged from 39% to 75%, with the majority (7/9) being single center studies. The combined overall proficiency of these studies calculated as a weighted average was 45.87%.

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Intraoperative Fiber-Optic Endoscopy for Ventricular Catheter Insertion

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100052562 ◽

2001 ◽

Vol 28 (1) ◽

pp. 56-60 ◽

Cited By ~ 15

Author(s):

Philip V. Theodosopoulos ◽

Aviva Abosch ◽

Michael W. McDermott

Keyword(s):

Fiber Optic ◽

Catheter Placement ◽

Ventricular Catheter ◽

Neurosurgical Procedure ◽

Significant Difference ◽

Catheter Tip ◽

Endoscopic Guidance ◽

Ventricular Catheters ◽

Tip Position ◽

Optic Endoscopy

ABSTRACT:Objective:Ventricular catheter placement is a common neurosurgical procedure often resulting in inaccurate intraventricular positioning. We conducted a comparison of the accuracy of endoscopic and conventional ventricular catheter placement in adults.Methods:A retrospective analysis of data was performed on 37 consecutive patients undergoing ventriculo-peritoneal shunt (VPS) insertion with endoscopy and 40 randomly selected, unmatched patients undergoing VPS insertion without endoscopy, for the treatment of hydrocephalus of varied etiology. A grading system for catheter tip position was developed consisting of five intraventricular zones, V1-V5, and three intraparenchymal zones, A, B, C. Zones V1 for the frontal approaches and V1 or V2 for the occipital approaches were the optimal catheter tip locations. Postoperative scans of each patient were used to grade the accuracy of ventricular catheter placement.Results:Seventy-six percent of all endoscopic ventricular catheters were in zone V1 and 100% were within zones V1-V3. No endoscopically inserted catheters were observed in zones V4, V5 or intraparenchymally. Thirty-eight percent of the conventionally placed catheters were in zone V1, 53% in zones V1-3 and 15% intraparenchymally. There was a statistically significant difference in the percentage of catheters in optimal location versus in any other location, favoring endoscopic guidance (p<0.001).Conclusion:We conclude that endoscopic ventricular catheter placement provides improved positioning accuracy than conventional techniques.

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