Spinal catheters

[loveumms]

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who here is using spinal catheters?

We had a demo on a FDA approved spinal catheter last week - I have yet to use it in clinical practice and it was a little complicated to learn (although I've done a few non-approved spinal catheters using the epidural kits).

I'm very excited about using these for hips and repeat knee replacements. Seems it might be good for a few other surgeries - possibly for intraabdominal cases in pts with severe lung disease, LONG c-sections (I'm at an academic institution where we can have 2-3 hour c-sections.

I wanted to see if there are others with experience. Anyone left them in post-op? Seems kinda dangerous but if well monitored and labeled might be nice for chronic pain patients.

 

[Planktonmd]

who here is using spinal catheters?

We had a demo on a FDA approved spinal catheter last week - I have yet to use it in clinical practice and it was a little complicated to learn (although I've done a few non-approved spinal catheters using the epidural kits).

I'm very excited about using these for hips and repeat knee replacements. Seems it might be good for a few other surgeries - possibly for intraabdominal cases in pts with severe lung disease, LONG c-sections (I'm at an academic institution where we can have 2-3 hour c-sections.

I wanted to see if there are others with experience. Anyone left them in post-op? Seems kinda dangerous but if well monitored and labeled might be nice for chronic pain patients.

Could you provide more info on this FDA approved spinal catheter?

 

[Wiscoblue]

The risk of infection is pretty high. Even if I used one for the surgery, I would probably pull it at the end of surgery.

 

[sevoflurane]

who here is using spinal catheters?

We had a demo on a FDA approved spinal catheter last week - I have yet to use it in clinical practice and it was a little complicated to learn (although I've done a few non-approved spinal catheters using the epidural kits).

I'm very excited about using these for hips and repeat knee replacements. Seems it might be good for a few other surgeries - possibly for intraabdominal cases in pts with severe lung disease, LONG c-sections (I'm at an academic institution where we can have 2-3 hour c-sections.

I wanted to see if there are others with experience. Anyone left them in post-op? Seems kinda dangerous but if well monitored and labeled might be nice for chronic pain patients.

Use them from time to time. Good go to regional for certain situations. I just use a stiff catheter (only time I bust one out) and a 17g touhy. Although not my practice, it is and has been popular to leave them in if you or a partner get an accidental intrathecal puncture on the L&D floor. Easy to just go ahead and thread an IT catheter. The risky part of it, as you eluded, is leaving an IT catheter in place with nurses that might misunderstand those to be epidurals... so there are some logistic hurdles to overcome if you are going to leave them in.

Absolutely agree that severe lung disease is a great indication, although if too severe, knocking out the intercostals might cause some restlessness and more problems than a carefully planed LMA anesthetic. So these can become more complicated if one isn't careful. Of course, the beauty of it is that you can dose up your level at a rate that attenuates these complications. GA related atelectasis as well as absorption atelectasis (if you are needing to give 100% O2) are issues to ponder when dealing with those who are hypoxic on NC, tachypneic at rest and have a documented history of COPD/respiratory complications.

The last handful I have performed have been strictly super sick super old patients going for TFN's.
IT catheters might be good for those whose PA pressures that are close to systemic. If these same patients have intolerances to pain and narcotics, it might be worth a shot. Couple months back I chose an IT anesthetic on an 80 y/o w/estimated PA pressures in the 90's. LR wide open as I dosed it up.

What I don't like about them is that it takes time to do it right.

Get some experience with them if you want. You're not likely to get a complication for a 1-2 hour ortho procedure. Pull it at the end for those.

 

[sevoflurane]

Oh... and if you run into low Bps on the PA cripples, I usually choose Vasopressin in small amounts over pure alpha or mix alpha agonists.

 

[sevoflurane]

Some people prefer .5% isobaric bupivicaine. This is what I use, but there is room for debate over the particular agent.

 

[OB1🤙]

I do a handful a year, in similar patients to those described above. My last was on a pt with severe mitral stenosis (deemed inoperable due to h/o prev cardiac surgery x 2) and near systemic PA pressures for THA.

I use a regular old epidural kit.

As sevo says, the main downside is that it takes time to dose up right if you're using it for these sick pts. I usually use 0.25% isobaric bupi, start with 5mg and give a cc more prn. I've described this before on this site but I get a stopcock, put it on the end of the catheter, withdraw a little CSF into a syringe on one port, give the local in the other, then flush with the withdrawn CSF.

For anything else (i.e. slow orthopod or OB but healthy patient), I think a plain old CSE should usually suffice. On the rare occasion the epidural ends up being spotty, just convert, but that won't happen very often. Hasn't happened to me yet in practice.

 

[loveumms]

Could you provide more info on this FDA approved spinal catheter?

I forget the name. Next time I'm at work, I'll get the name of it. We just started using them and had to go through all this inservice to be 'approved' to use them. Very interesting insertion.

 

[imfrankie]

I forget the name. Next time I'm at work, I'll get the name of it. We just started using them and had to go through all this inservice to be 'approved' to use them. Very interesting insertion.

Anybody ever run narcotic only, e.g. sufenta infusion, through these? I've been curious as to the potential analgesic efficacy.

 

[Mman]

I've described this before on this site but I get a stopcock, put it on the end of the catheter, withdraw a little CSF into a syringe on one port, give the local in the other, then flush with the withdrawn CSF.

Why the stopcock? After your initial dose, the miniscule volume of the catheter is filled with nothing but local anesthetic so each subsequent redose is precisely what you give in the syringe assuming you aren't changing concentrations between doses. And the volume of the epidural catheter probably isn't worth worrying about.

just my 2 cents

 

[OB1🤙]

Why the stopcock? After your initial dose, the miniscule volume of the catheter is filled with nothing but local anesthetic so each subsequent redose is precisely what you give in the syringe assuming you aren't changing concentrations between doses. And the volume of the epidural catheter probably isn't worth worrying about.

just my 2 cents

Just to prime the catheter with fluid rather than air prior to the initial injection, and to keep the doses given consistent and discrete. It's definitely not necessary as you point out, but it works for me.

 

[epidural man]

who here is using spinal catheters?

We had a demo on a FDA approved spinal catheter last week - I have yet to use it in clinical practice and it was a little complicated to learn (although I've done a few non-approved spinal catheters using the epidural kits).

I'm very excited about using these for hips and repeat knee replacements. Seems it might be good for a few other surgeries - possibly for intraabdominal cases in pts with severe lung disease, LONG c-sections (I'm at an academic institution where we can have 2-3 hour c-sections.

I wanted to see if there are others with experience. Anyone left them in post-op? Seems kinda dangerous but if well monitored and labeled might be nice for chronic pain patients.

We have them at our hospital. I haven't used them however - others have though. They have too many steps. I think if I needed an intrathecal catheter, I'd just use the epidural tray. The best spinal needle every created is a 17g tuohy.