How many days can I run a popliteal Catheter?

[turnupthevapor]

nican verses deer on a motorcycle. How long would you guys leave a popliteal catheter running. He is still in an ex fix and won't be getting an operation until later in the week. He is already on day five.

I remember the guys at Walter Reed, telling me they would run post amputation catheters for two weeks, but I didn't know if that was a special occasion? you guys think I should take it out for a few days and replace it? exchange it for a new one? or just leave it alone? Looks like he'll be in the hospital for the month. It'll be a few operations on this leg.

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[Ronin786]

I'd also be worried about potential nerve injury from local for a prolonged period of time. Not a lot of data out there, but longer isn't always better

As far as infection risk goes, 4-7 days is where it starts to go up. We don't keep our epidurals past 7 days, and usually don't have people with PNBs that long.

Prolonged Catheter Use and Infection in Regional Anesthesia: A Retrospective Registry Analysis

Ninety-nine percent of peripheral catheters and ninety-nine percent of epidural catheters were infection-free after four days. Infected catheters should be removed as soon as is practical.Supplemental Digital Content is available in the text.

pubs.asahq.org

 

[NumTacos]

2 weeks is likely doable, but why not just replace it after a week? If 2 weeks is necessary for some reason, I would just keep a close eye on it.

 

[usma05]

Yeah, we'd do caths for 10-14 days occasionally if needed at Wally World back in '11-14 but I think it was a unique situation with patient characteristics and pain team setup. I haven't seen something similar anywhere else I've worked and wouldn't recommend it without a robust pain team setup to monitor for infection. Im more of a 7-10 days cath guy if needed and pull/replace caths if still needed these days. And most patients i see these days get 2-3 cath days.

 

[lane]

Back in residency we had a patient (AKA one leg, BKA the other) that had bilateral femoral and sciatic catheters for 2 weeks

 

[pgg]

I remember the guys at Walter Reed, telling me they would run post amputation catheters for two weeks, but I didn't know if that was a special occasion?

To state the obvious , those patients are special because they're not going to get foot drop from nerve injury, because they don't have a foot any more.

Also, at the time Feres Doctrine influenced some of the risk/benefit decisions being made about nerve blocks and catheters (duration of infusion, drug cocktails, doing the procedures under general anesthesia, placement near contaminated wounds).

In other patients, the risk of nerve injury from prolonged exposure to local anesthetics carries different potential consequences for both patient and doctor.

 

[teacher2md]

Back in residency we had a patient (AKA one leg, BKA the other) that had bilateral femoral and sciatic catheters for 2 weeks

😂😂

God, I remember the dumb **** we had to do in residency just because it was plausible

 

[Maz777]

4-7 days is acceptable and within standard of care. You can leave in longer but the likelihood of infection increases dramatically after day 5. In all honestly, LE exfixes aren't all that painful for the average person. Can remove at 1 week (or sooner) and then re-block at the time of ORIF if the patient wants it. I manage these patients' pain every day.

 

[cchoukal]

In all honestly, LE exfixes aren't all that painful for the average person.

To wit: the other day I saw a homeless guy riding a bike with an ex-fix in place. No catheter required.

 

[pgg]

To wit: the other day I saw a homeless guy riding a bike with an ex-fix in place. No catheter required.

Idle thought

Makes you wonder if instead of the $17,000 or whatever that ex fix cost, he'd have been better off with a cast and $17,000 in services to make him less homeless.

 

[cchoukal]

Idle thought

Makes you wonder if instead of the $17,000 or whatever that ex fix cost, he'd have been better off with a cast and $17,000 in services to make him less homeless.

Sounds like UBI...

*apologizes for hijack*

 

[psychbender]

To state the obvious , those patients are special because they're not going to get foot drop from nerve injury, because they don't have a foot any more.

Also, at the time Feres Doctrine influenced some of the risk/benefit decisions being made about nerve blocks and catheters (duration of infusion, drug cocktails, doing the procedures under general anesthesia, placement near contaminated wounds).

The ****-ton of narcotics those guys would be on also affected the r/b equation. "Maaaybe we can avoid getting to Oxy 80mg TID, plus 15-20 q4prn if we keep this PNC going for another week!" Lots of cowboy **** done in the name of "the lesser evil" back then. Fun times.

 

[Howard888]

Exparel popliteal block last 4-5 days. Just repeat one at 4 days. 8 days should be good. Saphenous doesn’t last as long-2 days. So if need both different story but for sciatic just Exparel x 2

 

[Maz777]

Idle thought

Makes you wonder if instead of the $17,000 or whatever that ex fix cost, he'd have been better off with a cast and $17,000 in services to make him less homeless.

No no. Heresy.

How would the hospital get that incredibly sweet Medicaid payout? How would Ortho get that wRVU money? Think of the children please.

 

[Maz777]

Exparel popliteal block last 4-5 days. Just repeat one at 4 days. 8 days should be good. Saphenous doesn’t last as long-2 days. So if need both different story but for sciatic just Exparel x 2

Or just save a bunch of money and inject saline around the sciatic nerve. Similar opioid-sparing effect. Bill it as a trigger point injection of the sciatic nerve. Win win.

 

[pgg]

Exparel popliteal block last 4-5 days. Just repeat one at 4 days. 8 days should be good. Saphenous doesn’t last as long-2 days. So if need both different story but for sciatic just Exparel x 2

Sure but whether you accomplish a super long duration block with a catheter vs a depo of liposomal bupivacaine is kind of beside the point. All local anesthetics are at least a little bit neurotoxic, and I think the issue at hand here is whether it's a good idea to bathe a nerve in them for 1-2+ weeks, absent a really compelling reason to do so.