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LETTER TO EDITOR
Year : 2013  |  Volume : 57  |  Issue : 3  |  Page : 318-319  

Epidural catheter kinking over the scapular margins


Department of Anaesthesia, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India

Date of Web Publication25-Jul-2013

Correspondence Address:
Manish Tandon
Anaesthesia, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi - 110 070
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.115596

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How to cite this article:
Tandon M, Pandey CK, Pandey VK. Epidural catheter kinking over the scapular margins. Indian J Anaesth 2013;57:318-9

How to cite this URL:
Tandon M, Pandey CK, Pandey VK. Epidural catheter kinking over the scapular margins. Indian J Anaesth [serial online] 2013 [cited 2019 Dec 15];57:318-9. Available from: http://www.ijaweb.org/text.asp?2013/57/3/318/115596

Sir,

Continuous epidural analgesia is an effective modality for peri-operative pain management. However, epidural analgesia may fail due to kinking or knotting of the epidural catheter. [1],[2] We are reporting the inadvertent blockade of the epidural catheter secondary to its routing from over the scapula.

A patient was posted for exploratory laparotomy and an epidural catheter was placed in sitting position at T11-12 space. The epidural catheter was secured at the puncture point using an epidural fixation device. Test dose was injected easily using a 5-ml syringe and subsequently, the catheter was fixed using transparent sterile adhesive dressing to the patient's back. The patient was laid supine, and standard monitoring was attached. The epidural catheter was connected for continuous infusion of local anaesthetic at 7 ml/hour with a syringe pump. General anaesthesia was induced and invasive arterial and central venous lines were inserted. The patient was positioned with the arms by his side. Approximately 1 hour since induction of the anaesthesia, when the surgery had just started, infusion pump started giving occlusion alarm. Manual injection using the 5-ml syringe confirmed the alarm. Surgery was interrupted and the patient was turned to one side to allow inspection of the epidural catheter. Manual palpation of the epidural catheter did not reveal kinking. The adhesive dressing on the epidural catheter was removed and the catheter was inspected and palpated. No kink could still be appreciated. However, when the catheter was palpated firmly against the back of the patient with the arms of the patient by his side, the kinks became obvious at the margins of the scapula. Rerouting the catheter away from the scapular margins resolved the obstruction. Such corrective measure may not always be possible especially if the surgery has progressed to an advanced stage.

An epidural catheter warmed to the body temperature is softened and may kink under the surface of the skin. [3] We used a warming mattress besides other temperature maintaining strategy. This could have softened the catheter and made it prone to kink under the weight of the patient against the scapular margins which become prominent when the arms were positioned by the side of the patient. We suggest that caution should be exercised when warming mattress is used in patients with an epidural catheter and an epidural catheter should be secured away from scapular margins to prevent any potential blockade due to kinking.

 
   References Top

1.Hermanides J, Hollmann MW, Stevens MF, Lirk P. Failed epidural: Causes and management. Br J Anaesth 2012;109:144-54.  Back to cited text no. 1
[PUBMED]    
2.Hilton G, Jette CG, Ouyang YB, Riley ET. Kinked Perifix® FX Springwound epidural catheters. Can J Anaesth 2011;58:413-4.  Back to cited text no. 2
[PUBMED]    
3.Cohen S, Morlend R. Suturing epidural catheters. Anaesthesia 2000;55:1233.  Back to cited text no. 3
    




 

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