ASRA GUIDELINES....femoral catheters

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turnupthevapor

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Anyone have any insight on pulling femoral catheters while on lovenox? I am a conservative guy and follow epidural guidelines....

what do you all think? see case reports below

http://www.anesthesia-analgesia.org/content/103/4/1036.full

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agree with above, we pull fem and other compressible site catheters at any time. Lumbar plexus on the other hand we treat almost like epidurals.
 
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Those pictures in the above link don't make you nervous?:eek: These are case reports of hematoma after removing the catheter in pts on lovenox. I don't think it is a non issue
 
Those pictures in the above link don't make you nervous?:eek: These are case reports of hematoma after removing the catheter in pts on lovenox. I don't think it is a non issue

Well, they make me nervous, but they are case reports, after all, and even the case reports didn't have permanent sequelae. Some bruising and delay of PT and discharge - not quite on the level of an emergent decompressive laminectomy with risk of paralysis. Worth getting worked up about? Maybe - style and patient satisfaction with the block do count, after all.

I don't know what the overall incidence of a large hematoma is after removing a PNC in an anticoagulated patient. Is it higher than the incidence of other regional complications like nerve damage or seizures or dropped lungs? We take reasonable steps to reduce the risk of those complications, but they happen, and we just accept that risk.

Their decision to delay removal until 6 h after the LMWH looks like a reasonable step to me, but the data sure doesn't rise to the level of warranting a practice guideline. Maybe 5 minutes of local pressure and observation after removal would be sufficient.


All that said, I follow the neuraxial guidelines for placement of PNBs and removal of PNB catheters. It was the departmental policy at my residency program, and though it embarrasses me to admit it, it's one of those things I do just because I've always done it that way, even though I always thought a 12/24 h delay was excessive. In the end it doesn't cost anything and is only rarely an inconvenience.
 
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