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Difficulty in Removal of Continuous Lumbar Epidural Catheter Placed in Healthy Parturient for Labor Analgesia
Abstract Number: SUN-68
Abstract Type: Case Report/Case Series
A 32-year-old G2P1 parturient underwent uneventful placement of (L3-L4) lumbar epidural catheter, which provided excellent labor analgesia. Multiple attempts to remove the catheter were unsuccessful, leading to stretching and lengthening of the catheter, therefore Interventional radiology was consulted. The patient had been ambulating, and sensation and strength had been preserved in both lower extremities. The catheter was eventually removed utilizing a left-lateral steep fetal position, applying moderate continuous pressure while bolusing saline through the catheter lumen. The catheter showed evidence of kinking as pictured.
This poster presentation will address the following learning objectives:
Recognizing that difficulty with removal of continuous catheters is a rare complication of neuraxial anesthesia.
Evaluating and assessing a continuous epidural catheter that is difficult to remove and identifying various etiologies that may contribute to this complication.
Applying positional and pharmaceutical techniques, as well as other other neuraxial approaches, in order to facilitate removal of a difficult-to-remove epidural catheter.
Knowing when to justify consultation of other services such as interventional radiology or neurosurgery for aid in removal of these catheters.
Describing potential morbidities involved with epidural catheters that are not easily removed.
Chestnut, David H., and Cynthia A. Wong. Chestnut's Obstetric Anesthesia: Principles and Practice. 5th ed. Philadelphia: Elsevier Health Sciences, 2014. Print. Chapter 23. 460-505.
Ben-David, B., and R. Rawa. "Complications of Neuraxial Blockade."Anesthesiol Clin North America 20.3 (2002): 669-93. Web.
Roddin MJ, Dancey FM. Kinking of epidural catheters. Anaesthesia. 2000;55:831.
Asai T, Yamamoto K, Hirose T, Taguchi H, Shingu K. Breakage of epidural catheters: a comparison of an arrow reinforced catheter and other nonreinforced catheters. Anesth Analg. 2001;92:246–248.
Chen, Jia-Lin, Chen-Hwan Cherng, Shun-Ming Chan, Chia-Shang Lin, Chih-Shun Wong, Chun-Jung Juan, and Chun-Chang Yeh. "Difficult Removal of an Epidural Catheter in the Anterior Epidural Space."Acta Anaesthesiologica Taiwanica 48.1 (2010): 49-52.
Al-Kayed, O., F. Al-Bouti, and M. O. Arabneh. "Surgical Removal of a Looped and Knotted Epidural Catheter in a Postpartum Patient."M.E.J. Anesthesiology 19.4 (2008): 913-18.