Tunneled epidural catheters

[jimbomd]

We are starting to explore placing tunneled epidurals for cancer pain patients, wondering if anyone has any advice for kits/manufacturers for these items.

---

Members don't see this ad.

 

[Aether2000]

Arrow spiral wound catheters can be tunneled easily- place a Huber metal stylette epidural needle, advance the catheter, use a scalpel blade to make a small incision at the Huber needle insertion site into the skin, pass a 3-0 nylon suture through both sides of the skin of the incision but do not tie, pass the stylette laterally from the incision and exit through the skin, remove the Huber needle and place the tip on the tip of the stylette, in one motion pass the Huber needle from the lateral exit point of the stylette to the incision keeping pressure on the Huber needle and stylette simultaneously, thread the catheter through the subcutaneous Huber needle and out through the lateral exit point, hold the catheter at the incision site while removing the subcutaneous Huber needle. Tie the stitch in the incision. Place a second nylon stitch in the skin just lateral to the catheter exit point and tie the catheter in a knot (will not kink) around the skin stitch.

 

[Orin]

Why?

Intrathecal > epidural
Internal > external

If you're going to do an external pump for an epidural system, I'd use an epidural port and tunneling it far lateral region to facilitate supine access. We don't have any at our site but there are quite a few vendors out there, and you could talk to your IR guys about what they use vendor wise to simplify stuff.

Epidural Access Tray Port-A-Cath II Low Profile Tuohy 16 Gauge

I prefer the buried intrathecal catheter when an internal pump is unreasonable