To the Editor
In response to the letter “Broken Epidural Catheter Provokes Investigation, Algorithm Application” (APSF Newsletter, Fall 2000), I would like to report a similar instance of catheter separation using the Abbott Wire Tip Epidural Catheter. Our patient, a healthy gentleman, underwent a total knee arthroplasty solely under epidural anesthesia. The catheter was placed at the L2-3 interspace with the patient in a sitting position without difficulty and provided excellent anesthesia for the duration of the procedure. The catheter was left in place for 3 post-operative days with excellent pain relief.
Upon removal of the catheter by the surgical floor nurse assigned to the patient, resistance was encountered. At this point a second nurse attempted to extract the catheter with further application of force. Positioning of the patient at this time could not later be determined. The catheter was successfully removed but the wire tip of the catheter was found to be stretched with evidence of separation of the tip of the wire. This was confirmed by X-rays (PA and lateral) which showed approximately 1 – 1 1/2 inch of wire remaining within the epidural space extending into the interspinous ligament. Consultation with pain management colleagues suggested that the position of the catheter showed it to be caught in the facet joint at L2-3. It was felt that patient positioning during the catheter extraction caused the wire tip to be “pinched” by the joint, which caused shearing of the distal wire during the forceful removal of the catheter.
It should be noted that the patient reported no complaints related to the remaining wire fragment. According to our pain consultant, the catheters are implant tested and should pose no long-term problems for the patient.
James Jarrett, MD
North Houston (TX) Anesthesiologists