1Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Outline
Epidural catheter knotting is a very rare complication for epidural analgesia. We reported a woman with epidural catheter knotting for labor analgesia. The epidural catheter was stuck while removing and concomitant with painful sensation. We failed to pull out the catheter during the initial attempt. After several attempts and changing the patient's position, we removed the catheter successfully and then found the knotting catheter. Literature review suggested too much insertion distance increasing the risks for epidural catheter coiling, bending or twisting and recommend that epidural catheter is better not inserted more than 5cm into the lumbar epidural space. There are also some recommended strategies to remove the catheter. The associated neurological symptoms should also be closely observed when epidural catheter knotting happened.
Catheter knotting; epidural catheter; epidural labor analgesia
References
Brichant JF, Bonhomme V, Hans P.
On knots in epidural catheters: a case report and a review of the literature.
Int J Obstet Anesth 2006; 15: 159–62
Renehan E M, Peterson R A, Penning J P, Rosaeg O P, Chow D.
Visualization of a looped and knotted epidural catheter with a guidewire.
Can J Anaesth 2000; 47: 329–333.
Muneyuki M, Shirai K, Inamoto A.
Roentgenographic analysis of the positions of catheters in the epidural space.
Anesthesiology 1970; 33: 19–24.
Blomberg R.
The dorsomedian connective tissue band in the lumbar epidural space of humans: an anatomical study using epiduroscopy in autopsy cases.
Anesth Analg 1986 ; 65 :747-52.
Scapinelli R.
Anatomical and radiologic studies on the lumbosacral meningo-vertebral ligaments of humans.
J Spinal Disord 1990; 3: 6 –15.
Shi B, Li X, Li H, Ding Z.
The morphology and clinical significance of the dorsal meningovertebra Ligaments in the lumbosacral epidural space.
Spine. 2012;37:E1093–8
Jiang, Huanwei & Shi, Benchao & Xu, Shiyuan.
An anatomical study of lumbar epidural catheterization.
BMC Anesthesiol. 2015; 15: 94.
Boey SK, Carrie LE.
Withdrawal forces during removal of lumbar extradural catheters.
Br J Anaesth 1994;73:833-5.
Morris GN, Warren BB, Hanson EW, Mazzeo FJ, DiBenedetto DJ.
Influence of patient position on withdrawal forces during removal of lumbar extradural catheters.
Br J Anaesth 1996;77:419-20
Hermanides J, Hollmann MW, Stevens MF, Lirk P.
Failed epidural: Causes and management.
Br J Anaesth. 2012;109:144–54.
Kim YR, Choi JW, Sim WS, Lee CJ, Chang C.
The influence of patient position on withdrawal force of lumbar epidural catheters after total knee arthroplasty: A randomized trial.
J Clin Anesth. 2016;34:98–104