black granules in CSF via catheter access port

[oreosandsake]

anyone else see this before?

stable chronic intrathecal morphine pump. we performed a catheter dye study today as the patient's pump battery will be replaced in 1 month.

we had trouble aspirating from the access port. pushed dye and had no leaks. appropriate myelogram. then were able to get 6 mL of CSF afterwards.

saw black granules in the CSF. almost chalk or charcoal like.

is this common?

also, does this scenario where we could not aspirate and then after a bolus through the catheter, could easily aspirate csf suggest there was a granuloma at the tip?

---

Members don't see this ad.

 

[Taus]

I have no idea what that stuff was...but as I'm sure you're aware- if you inject the contrast via the side port directly into the csf without first aspirating you also push through all medicine that was in the tubing..... ie very risky and generally a no no

 

[lobelsteve]

anyone else see this before?

stable chronic intrathecal morphine pump. we performed a catheter dye study today as the patient's pump battery will be replaced in 1 month.

we had trouble aspirating from the access port. pushed dye and had no leaks. appropriate myelogram. then were able to get 6 mL of CSF afterwards.

saw black granules in the CSF. almost chalk or charcoal like.

is this common?

also, does this scenario where we could not aspirate and then after a bolus through the catheter, could easily aspirate csf suggest there was a granuloma at the tip?

Saw it on last pump replacement. Rep says he sees it all the time. Reports due to compounding impurities. No data to support that.

 

[Aether2000]

Medtronic did an internal study that shows significant sludging within the catheter itself when admixtures were used. The sludge is a black precipitate that occurs in the catheter itself. If it were me, I would replace the catheter and pump.

 

[oreosandsake]

I have no idea what that stuff was...but as I'm sure you're aware- if you inject the contrast via the side port directly into the csf without first aspirating you also push through all medicine that was in the tubing..... ie very risky and generally a no no

Thanks.

yeah, i had wondered about that. he was getting about 8mg morphine over 24 hr period IT. the tube had 2mg in it. we kept him in the pacu for a while -- no issues. is there a protocol for what would be considered "safe" versus a "oh NO! he's not breathing now" bolus in this situation?

 

[oreosandsake]

Medtronic did an internal study that shows significant sludging within the catheter itself when admixtures were used. The sludge is a black precipitate that occurs in the catheter itself. If it were me, I would replace the catheter and pump.

Thank you for the reply!

the rep we had with us had never seen or heard of it. Interesting point. fwiw, this patient as far as i know has never had anything else in the pump besides morphine.

also, any venture as to why we had trouble aspirating? and besides CT with dye how else can we tell if there is a granuloma at the tip?

 

[oreosandsake]

Saw it on last pump replacement. Rep says he sees it all the time. Reports due to compounding impurities. No data to support that.

Thanks Steve.

I spoke with a neurologist who called it something something... started with a F (not 4 letter word)

said it was from inflammation and precipate proteins from foreign object in the IT space. I will follow up on it

 

[NJPAIN]

I have no idea what that stuff was...but as I'm sure you're aware- if you inject the contrast via the side port directly into the csf without first aspirating you also push through all medicine that was in the tubing..... ie very risky and generally a no no

Sent from my iPhone using SDN Mobile

 

[NJPAIN]

Sent from my iPhone using SDN Mobile

Had one of the POS Infusaid pumps years ago that needed contrast study. MS/bupi. First and last one I ever put in. Had rep and their "specialist" fly in for Midwest. Took over one hour to access their version of side port. Thought we aspirated more than enough csf. Injected contrast, total spinal, violent muscle spasms as he awakened. Lawsuit - claimed permanent neuro injury. Never pump another pump in again. Nothing but trouble except in cancer patient.


Sent from my iPhone using SDN Mobile