Securing epiduarals

[stonemd]

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Anyone have any tips or tricks for best technique to minimize the number of postop analgesic epidural catheters that 'migrate out'? Glue? Tunnel? Statlock? Benzoin/mastisol? ... Would like to come up with a best reactive for our department.

 

[BobBarker]

Staples.

 

[sevoflurane]

My technique is quite simple. Benzoin (dab dry), then tegaderm, then copious medipore to reinforce. No problems.

 

[narcusprince]

Wipe patients back off from the initial amount of sweat. Benzoin, tegaderm tape around tegaderm. Get them comfortable quickly and efficiently that cuts down on back sweat and making sure no bubbles are in the tegaderm. I am not sure I have seen this phenomena much.

 

[stonemd]

The hints I need are for postop lumbar and thoracic epidurals that need to stay in for 3-8 days.

 

[pgg]

For obese patients, have them lay down before putting the dressing on, or the layer of fat can shift and pull the catheter a cm or two out of the epidural space. This is a bigger problem for lumbar catheters, especially labor epidurals with a patient who's going to be squirming around for hours. I haven't had much trouble with higher catheters - just benzoin, a small loop near the skin, tegaderm, sticky tape. Thoracotomy patients tend to be less squirmy though.

If it's a recurrent problem, consider putting an extra cm in the space to give yourself a little more margin of movement.

 

[narcusprince]

For some of the longer 7+ day catheters. Where I trained some of the catheters were tunnelled and that definetly decreased the incidence of displacment. http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2044.2000.01547-2.x/full
Small numbers in the study but good tips to decrease catheter displacement.

 

[psychbender]

Where I trained, we regularly had catheters (peripheral and epidural) remain in place for extended periods of time (7-10+ days). For epidurals, we almost never tunneled, and still did not have issues with catheters becoming dislodged (even with thrice-weekly OR trips, and regular PT/OT/trips around the hospital). What we found works best was dermabonding the catheter loops to the skin, steri-strips, and tegaderms. We had a lot of patients who developed severe superficial reactions to regular tape, and found that medipore tape tended to roll up, and take the tegaderm with it, increasing the chance of the catheter becoming dislodged after just a few days. However, dry skin on placement, and covering the site and whole length of the catheter up the back with tegaderms worked great. If a corner does seem to be rolling up when you round on it, remove that particular tegaderm and place a fresh one.

 

[Arch Guillotti]

For obese patients, have them lay down before putting the dressing on, or the layer of fat can shift and pull the catheter a cm or two out of the epidural space. This is a bigger problem for lumbar catheters, especially labor epidurals with a patient who's going to be squirming around for hours.

Agree with this. I have had catheters get sucked in up to 3 cm with some of the really big pregnant ladies.

 

[Triple AAA]

For a while, we used to use mastisol. But we abandoned that practice, as most of our catheters were short term.

 

[Femtochemistry]

8 days?? wow that's a long time. where i trained catheters were out by day 3 (rarely day 4). we had several local infections in catheters that were placed in for 5 days; and almost overnight, we changed our policy. infection rate decreased.

http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2044.2000.01547-2.x/full

no surprise the rate for local infection is 27%