epidural catheter tip

[sweetalkr]

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I was teaching a CA-1 some OB stuff and i realized I didn't know which imaging modality was preferred if the epidural catheter tip does not come out intact when pulling it. can anyone tell me is it Ct or MRI? then neursurg consult? thanks

 

[coprolalia]

I was teaching a CA-1 some OB stuff and i realized I didn't know which imaging modality was preferred if the epidural catheter tip does not come out intact when pulling it. can anyone tell me is it Ct or MRI? then neursurg consult? thanks

Depends on what kind of catheter, how much of it is left in, and how you plan on treating it ultimately.

For example, if I ever break-off a spring-wound, I ain't sendin' nobody for no stinkin' MRI before I talk to Neurosurgery. Of course, this has never happened and never will happen to me because I think spring-wound catheters are pieces of **** and I never use them... and, likewise, I've never broken-off a catheter off a straight polyacrylamide catheter in someone either. They don't break.

-copro

 

[pgg]

I was teaching a CA-1 some OB stuff and i realized I didn't know which imaging modality was preferred if the epidural catheter tip does not come out intact when pulling it. can anyone tell me is it Ct or MRI? then neursurg consult? thanks

CT is preferred. MRI would be very bad (for obvious reasons) for catheters with ferromagnetic parts, plus there'd be an artifact problem. Neurosurgery consultation only if the catheter was intrathecal or if the patient's symptomatic. In most cases retrieval isn't indicated.

Reasons to go after a fragment may include intrathecal catheters (risk of persistent CSF leakage), if part of the catheter lies outside the skin or has retracted into subcutaneous tissue (higher risk of infection tracking to the epidural space), if the patient is a child (potentially longer period of exposure), or if the catheter has ferromagnetic components (which could complicate future MRI studies). There's a decent review article on the subject from Fleischmann et al, Journal of Clinical Anesthesia - Vol 19 #4 (2007).

Like copro, I don't ever intend to have this complication. 🙂

 

[seinfeld]

If its left in , is the patient a candidate for future neuroaxial techniques?