TITLE:
The Difficulty to Remove Perineural Catheter: A Technique for Removing an Intact Catheter
AUTHORS:
Babak Khabiri, Charles Hamilton, John Norton, Fernando Arbona, Laurah Carlson
KEYWORDS:
Regional Anesthesia; Ultrasound; Peripheral Nerve Catheter; Acute Pain Management
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.6,
July
26,
2013
ABSTRACT: Continuous perineural catheters are
used for postoperative pain management following inpatient or outpatient orthopedic
surgery. One of the potential complications is shearing and breaking of the
catheters during removal. The metallic coiled tip Stimu Cath catheter may contribute to
formation of adhesions. Depletion of the local anesthetic infusion prior to attempted
removal of the catheter may contribute to formation of adhesions around the
catheter. Once the infusion of local anesthetic is finished, there is no longer
a pocket of fluid around the catheter and tissue may begin to collapse and form
adhesions, making removal difficult. Our strategy in dealing with a catheter
that is difficult to remove is to keep the catheter connected to the pump,
avoiding contamination as well as preserving the integrity of the catheter by
avoiding shearing and breakage. One of the concerns with a “stuck” catheter is
that the catheter may have adhered to a neural structure and that pulling and
tugging could cause nerve damage. Prior to manipulating the catheter, we
perform an ultrasound examination to ascertain its exact location, we then
bolus sterile saline through the catheter. We feel that infusing 30 to 50 ml of
sterile saline, slowly and incrementally will expand the area around the
catheter and aid in removal without significant risk of compression neuropathy.