scholarly journals A Rare Presentation of Broken Epidural Catheter

2020 ◽  
Vol 6 (2) ◽  
Keyword(s):  
Epidural Catheter ◽  
Epidural Space ◽  
Successful Management ◽  
Rare Presentation ◽  
Post Operative Period ◽  
Epidural Catheters

We routinely use epidural catheters for intra operative and post operative analgesia. Although there are many known complications of epidural catheters, breakage of the catheter is a rarely encountered but well known complication. We report one such event in post operative period and its successful management. Keywords: Epidural catheter; Epidural space; Documentation; Counselling.

scholarly journals Using Computed Tomography Scans and Patient Demographic Data to Estimate Thoracic Epidural Space Depth

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Alyssa Kosturakis ◽  
Jose Soliz ◽  
Jackson Su ◽  
Juan P. Cata ◽  
Lei Feng ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Epidural Catheter ◽  
Epidural Space ◽  
Depth Measurement ◽  
Thoracic Epidural ◽  
Patient Demographics ◽  
Loss Of Resistance ◽  
Computed Tomography Scans ◽  
The Mean ◽  
Epidural Catheters

Background and Objectives. Previous studies have used varying methods to estimate the depth of the epidural space prior to placement of an epidural catheter. We aim to use computed tomography scans, patient demographics, and vertebral level to estimate the depth of the loss of resistance for placement of thoracic epidural catheters. Methods. The records of consecutive patients who received a thoracic epidural catheter were reviewed. Patient demographics, epidural placement site, and technique were collected. Preoperative computed tomography scans were reviewed to measure the skin to epidural space distance. Linear regression was used for a multivariate analysis. Results. The records of 218 patients were reviewed. The mean loss of resistance measurement was significantly larger than the mean computed tomography epidural space depth measurement by 0.79 cm (p<0.001). Our final multivariate model, adjusted for demographic and epidural technique, showed a positive correlation between the loss of resistance and the computed tomography epidural space depth measurement (R2=0.5692, p<0.0001). Conclusions. The measured loss of resistance is positively correlated with the computed tomography epidural space depth measurement and patient demographics. For patients undergoing thoracic or abdominal surgery, estimating the loss of resistance can be a valuable tool.

scholarly journals Eyes in the Needle

2011 ◽  
Vol 114 (6) ◽  
pp. 1320-1324 ◽  
Author(s):  
Huihua K. Chiang ◽  
Qifa Zhou ◽  
M. Susan Mandell ◽  
Mei-Yung Tsou ◽  
Shih-Pin Lin ◽  
...  
Keyword(s):  
Epidural Catheter ◽  
Dura Mater ◽  
Epidural Space ◽  
Dural Puncture ◽  
Ligamentum Flavum ◽  
Needle Insertion ◽  
Epidural Needle ◽  
Average Weight ◽  
Ultrasound Probe ◽  
Epidural Catheters

Background Epidural needle insertion is usually a blind technique where the rate of adverse events depends on the experience of the operator. A novel ultrasound method to guide epidural catheter insertion is described. Methods An ultrasound transducer (40 MHz, a -6 dB fractional bandwidth of 50%) was placed into the hollow chamber of an 18-gauge Tuohy needle. The single crystal was polished to a thickness of 50 μm, with a width of 0.5 mm. Tissue planes were identified from the reflected signals in an A-mode display. The device was inserted three times into both the lumbar and thoracic regions of five pigs (average weight, 20 kg) using a paramedian approach at an angle of 35-40°. The epidural space was identified using signals from the ligamentum flavum and dura mater. Epidural catheters were placed with each attempt and placement confirmed by contrast injection. Results The ligamentum flavum was identified in 83.3% of insertions and the dura mater in all insertions. The dura mater signal was stronger than that of the ligamentum flavum and served as a landmark in all epidural catheter insertions. Contrast studies confirmed correct placement of the catheter in the epidural space of all study animals. Conclusions This is the first study to introduce a new ultrasound probe embedded in a standard epidural needle. It is anticipated that this technique could reduce failed epidural blocks and complications caused by dural puncture.

Prospective Examination of Epidural Catheter Insertion

1996 ◽  
Vol 84 (1) ◽  
pp. 88-93 ◽  
Author(s):  
Robert D'Angelo ◽  
Brenda L. Berkebile ◽  
J. C. Gerancher
Keyword(s):  
Epidural Analgesia ◽  
Epidural Catheter ◽  
Cesarean Delivery ◽  
Epidural Space ◽  
Local Anesthetic ◽  
Catheter Insertion ◽  
Labor And Delivery ◽  
Prolonged Labor ◽  
Epidural Catheters ◽  
Insertion Length

Background Although it is generally accepted that inserting epidural catheters 3-4 cm into the epidural space minimizes complications, no prospective randomized examination of epidural catheter insertion length has been published. Methods Eight hundred healthy parturients requesting epidural analgesia were randomized to have open-tip epidural catheters inserted 2, 4, 6, or 8 cm within the epidural space. The incidences of intravenous cannulation, unilateral sensory analgesia, and subsequent catheter dislodgment were recorded. Catheter insertions that resulted in intravenous cannulation or unilateral analgesia were incrementally withdrawn and retested with additional local anesthetic to determine the effectiveness of epidural catheter manipulation. Results Epidural catheters inserted 8 cm within the epidural space were more likely to result in intravenous cannulation. Epidural catheters inserted 2 cm within the epidural space were less likely to result in unilateral sensory analgesia but were more likely to become dislodged. Twenty-three percent of epidural catheters inserted &gt; 2 cm within the epidural space required manipulation. Epidural catheters inserted 2 or 4 cm required replacement more often than epidural catheters inserted 6 or 8 cm. Ninety-one percent and 50% of epidural catheters that resulted in unilateral sensory analgesia and intravenous cannulation, respectively, provided analgesia for labor and delivery after incremental withdrawal. Conclusions Epidural catheters should be inserted either 2 cm when rapid labor is anticipated or 6 cm when prolonged labor or cesarean delivery is likely. Additionally, epidural catheters that result in intravenous cannulation or unilateral sensory analgesia can be manipulated effectively to provide analgesia for labor and delivery.

Changes in the Position of Epidural Catheters Associated with Patient Movement 

1997 ◽  
Vol 86 (4) ◽  
pp. 778-784 ◽  
Author(s):  
Catherine L. Hamilton ◽  
Edward T. Riley ◽  
Sheila E. Cohen
Keyword(s):  
Epidural Catheter ◽  
Epidural Space ◽  
Lateral Position ◽  
Lateral Decubitus Position ◽  
Position Change ◽  
Catheter Position ◽  
Space Length ◽  
Lateral Decubitus ◽  
Clinically Significant ◽  
Epidural Catheters

Background Epidural catheter movement has been noted with change of patient position and can result in inadequate anesthesia. This study was designed to measure movement and to develop a technique that minimizes catheter displacement. Methods In 255 parturients requesting epidural anesthesia for labor or cesarean section, a multiorificed lumbar epidural catheter was inserted with the patient in the sitting flexed position. The distance to the epidural space, length of catheter inserted, and amount of catheter position change as the patient moved from the sitting flexed to sitting upright and then to the lateral decubitus position were measured before the catheter was secured to the skin. Adequacy of analgesia, the need for catheter manipulation, and whether the patient was considered obese were noted. Data were grouped according to body mass index (BMI): &lt; 25, 25-30, and &gt; 30 kg/m2. Results The groups did not differ with respect to the length of catheter initially inserted or changes in catheter position between initial taping and removal. The distance to the epidural space differed significantly among the groups, increasing with greater BMI. Catheters frequently appeared to be drawn inward with position change from the sitting flexed to lateral decubitus position, with the greatest change seen in patients with BMI &gt; 30. Only nine catheters were associated with inadequate analgesia, four of which were replaced. No analgesic failures occurred in the BMI &gt; 30 group. In patients judged by the anesthesiologist to be obese or to have an obese back, BMI was greater, and distance to the epidural space and the magnitude of catheter movement with position change were greater than in those who were not obese. Conclusions Epidural catheters moved a clinically significant amount with reference to the skin in all BMI groups as patients changed position. If catheters had been secured to the skin before position change, many would have been pulled partially out of the epidural space. To minimize the risk of catheter displacement, particularly in obese patients, we recommend that multiorificed catheters be inserted at least 4 cm into the epidural space and that patients assume the sitting upright or lateral position before securing the catheter to the skin.

Some pressure and fluid dynamic characteristics of the canine epidural space

1977 ◽  
Vol 232 (3) ◽  
pp. H255-H259
Author(s):  
R. G. Bengis ◽  
A. C. Guyton
Keyword(s):  
Epidural Space ◽  
Fluid Dynamic ◽  
Fluid Pressure ◽  
Simultaneous Recording ◽  
Positive Pressure ◽  
Pressure Curve ◽  
Epidural Pressure ◽  
Volume Depletion ◽  
Significant Drop ◽  
Epidural Catheters

Pressure measured in teh epidural space of 50 dogs was consistently negative (subatmospheric). Acutely implanted epidural catheters gave an average reading of -2.72 mmHg (n = 44, SE = 0.18), whereas chronically implanted catheters gave more negative readings, averaging -5.8 mmHg (n = 6, SE = 0.49). Since the chronically implanted catheters permit healing, resolution of hemorrhage, and resealing of the epidural space to take place, resulting in equilibration of microcirulatory forces, these readings are believed to represent more closely the true epidural pressure. Also these results approximate closely the calculated and measured interstitial fluid pressures obtained by different techniques in other loose areolar connective tissue systems. Compliance studies, using a double-lumen catheter for simultaneous recording and infusing in the epidural space, showed increasing compliance as the pressure rose into the positive pressure range, with an eventual plateau of the volume-pressure curve at the level of the concomitantly measured cerebrospinal fluid pressure (avg = +5.73 mmHg, n = 10, SE = 0.48). Intravenous volume loading using Tyrode solution caused a large rise in epidural pressure, and volume depletion with diuretics caused a significant drop in epidural pressure.

Predistention of the Epidural Space Before Catheter Insertion Reduces the Incidence of Intravascular Epidural Catheter Insertion

2008 ◽  
Vol 28 (2) ◽  
pp. 98-99
Author(s):  
S. Evron ◽  
V. Gladkov ◽  
D.I. Sessler ◽  
V. Khazin ◽  
O. Sadan ◽  
...  
Keyword(s):  
Epidural Catheter ◽  
Epidural Space ◽  
Catheter Insertion

Clinical and Bacteriologic Survey of Epidural Analgesia in Patients in the Intensive Care Unit

1996 ◽  
Vol 85 (5) ◽  
pp. 988-998 ◽  
Author(s):  
Bruno Darchy ◽  
Xavier Forceville ◽  
Eric Bavoux ◽  
Frederic Soriot ◽  
Yves Domart
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Epidural Analgesia ◽  
Epidural Catheter ◽  
Strong Predictor ◽  
Insertion Site ◽  
Space Infection ◽  
General Signs ◽  
Epidural Catheters

Background The risk of bacterial contamination related to epidural analgesia in patients cared for in the intensive care unit has not been assessed. Thus the authors studied patients who received care in the intensive care unit who were given epidural analgesia for more than 48 h to determine the rates of local, epidural catheter, and spinal space infection and to identify risk factors. Methods Each patient receiving epidural analgesia for longer than 48 h was examined daily for local and general signs of infection. A swab sample for culture was taken if there was local discharge; all epidural catheters were cultured on withdrawal. All patients underwent weekly neurologic monitoring for 1 month; those with positive epidural catheter cultures had one spinal magnetic resonance image scan. Results The 75 patients cared for in the intensive care unit who were studied had been receiving epidural analgesia for a median of 4 days (interquartile range, 3.5 to 5 days). Twenty-seven patients had signs of local inflammation (erythema or local discharge), and nine of these had infections. All the patients who had both local signs also had infection. All nine infections were local (12%), but four patients also had epidural catheter infections (5.3%). No patient with erythema alone or without local signs had a positive epidural catheter culture. No spinal space infection was diagnosed. Staphylococcus epidermidis was the most frequently cultured microorganism. Local infection was treated by removing the epidural catheter without any antibiotics. Concomitant infection at other sites (21 of 75 patients, or 28%), antibiotic therapy (64 of 75 patients, or 85%), the duration of epidural analgesia, and the insertion site level of the epidural catheter were not identified as risk factors for epidural analgesia-related infections. Conclusions The risk of epidural analgesia-related infection in patients in the intensive care unit seems to be low. The presence of two local signs of inflammation is a strong predictor of local and epidural catheter infection.

Patient-Controlled Epidural Analgesia/Continuous Epidural Catheters

2016 ◽  
Author(s):  
Devin Peck
Keyword(s):  
Epidural Catheter ◽  
Local Anesthetics ◽  
Catheter Placement ◽  
Labor Pain ◽  
Abdominal Incision ◽  
Tumor Spread ◽  
Epidural Catheter Placement ◽  
Thoracic Epidural ◽  
Cord Injury ◽  
Epidural Catheters

Although useful for management of many types of pain, the most common indication for epidural catheter placement is for management of labor pain. High lumbar and thoracic epidural catheter placement has gained increasing popularity in recent years for the management of postoperative pain. The technique is most commonly employed for procedures in which a thoracic or an extensive abdominal incision is anticipated. Absolute contraindications for epidural catheter placement include patient refusal, uncorrected hypovolemia, increased intracranial pressure, local infection at the planned site of insertion, and patient allergy to amide/ester local anesthetics. Relative contraindications include coagulopathy, an uncooperative patient, severe anatomic abnormalities of the spine, sepsis, and hypertension. The advantages include attenuation of the sympathetic response to surgical stimulation and pain; effects on the cardiovascular, respiratory, and gastrointestinal systems; thromboprotective effects; and possibly limitation of tumor spread. The risks of epidural catheter placement include epidural hematoma, infection, nerve or spinal cord injury, dural puncture, or respiratory or cardiovascular depression from a high block. Epidural opioids provide analgesia without causing motor or sympathetic blockade. Epidurally administered local anesthetics may result in decreased postoperative ileus, nausea, vomiting, and sedation, which can be associated with opioids. Local anesthetics and opioids act additively or synergistically and, when used together, can lead to a reduction in the dose of each drug. 

Inadvertent Placement of Epidural Catheter in the Extra-epidural Space - Two case reports -

2008 ◽  
Vol 54 (3) ◽  
pp. 335
Author(s):  
Young Song ◽  
Hae Keum Kil ◽  
Jang Eun Cho ◽  
Yong Seon Choi
Keyword(s):  
Epidural Catheter ◽  
Epidural Space ◽  
Case Reports
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