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///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00

Epidural Catheter Reconnection in the BD Spring-Wound Catheter CE

Abstract Number: 104
Abstract Type: Original Research

James A Dolak M.D., Ph.D.1 ; Deborah I Warth M.S., CRNA2

Introduction: Two catheter-connector separations involving the BD spring-wound epidural catheter CE occurred in our delivery suite. Conservative management of such separations involves cleaning the catheter with betadine approximately 12 cm from the fluid meniscus, cutting the sterile portion of the catheter, and reattaching a sterile connector. However, this strategy was described using non-spring-wound catheters. In our cases, initial attempts at catheter cutting were made using scalpel blades, which resulted in severing the plastic portion of the catheters, while leaving intact springs with obvious evidence of uncoiling. A second transection was then attempted on the proximal portion of the catheters using sterile scissors. In each case, this created a clean edge allowing connector reattachment, followed by successful use of the catheter. We decided to rigorously investigate this method of catheter trimming to see if it is successful in terms of catheter performance and structural integrity.

Methods: Fourteen BD spring-wound catheters were tested upon removal from post-partum women. Each catheter was cut with a #10 surgical blade 12 cm proximal to the connector-end of the catheter, then cut with surgical scissors 1cm more proximal, and finally cut 1 cm further in at the first portion of the distal window of the catheter. After each cutting with scissors, the connector was firmly attached to the cut edge, and 1 ml of sterile saline was injected and rated as easy, difficult or impossible. Structural integrity was investigated by tensioning the catheters with a larger force than required for removal, and looking for breakage or other failure.

Results: All catheters were easy to inject through at start of testing. No catheter was successfully cut with a scalpel blade - which led to transection of the plastic tubing followed by some degree of wire stripping. In all cases, scissors cut both the plastic and wire components of the spring wound catheter, leaving a clean edge in both the opaque- and window-portions of the catheter. Upon replacement of the connector on the catheter, we found that 13/14 catheters cut in the opaque area and 13/14 catheters cut in the window area were easy to inject with saline. No catheter lost structural integrity during testing.

Discussion: Epidural catheters are mated to infusion tubing with connectors, which can undergo accidental disconnection. This is usually due to operator error - including insufficient tightening or insufficient length of catheter insertion into the connector. Additionally, catheter-connector joints are often subject to physical strains in the obstetric forum which may contribute to their separation. We have determined that one type of spring-wound catheter, the BD spring-wound catheter CE, can be managed in the recommended manner as long as sterile scissors are used to cut the catheter. This does not appear to significantly alter its functional or structural integrity.

SOAP 2010