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Do Springwound Epidural Catheters Reduce Epidural Catheter Replacement Rate – Year 2013 analysis of 6124 deliveries
Abstract Number: F-20
Abstract Type: Original Research
Introduction: Epidural and combined spinal-epidural analgesia are commonly used for labor analgesia, however the incidence of catheter malfunction/failure has been reported to be over 10% by various authors. Springwound epidural catheters have been shown to reduce venous puncture compared with traditional nylon catheters because of their softness and flexibility. It is postulated that these same characteristics allow the springwound catheter to remain midline in the epidural space during insertion and are less likely to dislodge; leading to lower rates of catheter malfunction and/or replacement. Catheter data for both springwound and nylon closed tip epidural catheters was prospectively collected and analyzed for characteristics of malfunction or failure.
Method: After IRB approval, an analysis of effects of springwound vs nylon epidural catheter on obstetric anesthesia outcomes was conducted using quality assurance (QA) data collected from Jan 1-Dec 31, 2013. Data were compared between 2 periods–Jan to June (Nylon), when nylon closed tip epidural catheters were used versus July to Dec (Spring), when springwound ones were used. The ongoing QA program collected data on all complications (IV, intrathecal, neurological, and other systemic issues), epidural failures/malfunction, replacement, and time to replacement. Incidence of complications and their characteristics were compared between the Nylon and Spring groups. Interval data were analyzed by ANOVA ,while nominal data was analyzed by Chi-squares and Fisher's exact test as appropriate with P<0.05 considered significant.
Results: There were total of 6124 deliveries (4331 vaginal, 1793 cesarean), with 4468 neuraxial procedures (1986 epidural and 2482 CSE) performed. Overall epidural catheter replacement rate was 147/2169(6.8%) for Nylon and 108/2299(4.7%) for Spring (P<0.003) while the IV catheter rate was reduced from 73/2169(3.4%) to 12/2299(0.5%) (P<0.001). However, excluding IV catheters, the replacement rate, due to inadequate analgesia, was not different (4.9% -Nylon vs. 4.4% -Spring), as well as no difference in other complication rates (Table 1).
Conclusion: Our results show that springwound catheters do not reduce the epidural replacement rate in patients who did not have an inadvertent venous placement for both CSE and traditional epidural. However, the results do confirm that the inadvertent IV catheter rate was reduced by almost 7 fold following the introduction of springwound catheters.