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Table of Contents
LETTER TO EDITOR
Year : 2012  |  Volume : 28  |  Issue : 2  |  Page : 280

Intraluminal obstruction of epidural catheter due to manufacturing defect


Department of Anaesthesiology, MVJMC and RH, Hoskote, Bangalore, Karnataka, India

Date of Web Publication11-Apr-2012

Correspondence Address:
Prasad K Kulkarni
G-5, Geetanjali Icon Apartment, Nagavarpalya Mail Road, C V Raman Nagar, Bangalore - 93, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.94935

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How to cite this article:
Kulkarni PK, Pai VA, Shah RP, Joshi SR. Intraluminal obstruction of epidural catheter due to manufacturing defect. J Anaesthesiol Clin Pharmacol 2012;28:280

How to cite this URL:
Kulkarni PK, Pai VA, Shah RP, Joshi SR. Intraluminal obstruction of epidural catheter due to manufacturing defect. J Anaesthesiol Clin Pharmacol [serial online] 2012 [cited 2020 Dec 2];28:280. Available from: https://www.joacp.org/text.asp?2012/28/2/280/94935

Sir,

Catheter blockage due to manufacturing defect resulting in inability to deliver the drug is a rare cause of epidural failure. We recently encountered a manufacturing defect of an epidural catheter which manifested as intraluminal obstruction.

A 50-year-old smoker with peripheral vascular disease and gangrene of right lower limb was posted for below knee amputation. He was a known case of hypothyroidism on treatment with oral eltroxin 100 mcg once a day. Under strict asepsis, an 18 G epidural catheter (Perifix, B.Braun Medical Ind. Sdn. Bhd, Penang, Malaysia) was introduced, via the L2-L3 interspace, without any difficulty, through an18 G Tuohy epidural needle, and was fixed at 10 cm. 2% lignocaine with adrenaline 3 ml was injected as test dose, but there was resistance to the flow of the drug. We checked the connector assembly and found it to be in order. The catheter was withdrawn slowly by 0.5 cm twice but the resistance continued. It was presumed that either kinking of catheter or blockade due to blood clot as the cause for resistance and so we decided to redo the procedure. On inspection of the removed catheter we found two areas of flat, compressed zones [Figure 1]. Methylene blue dye was injected to confirm the obstruction.
Figure 1: Site of obstruction

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Failure rate of continuous epidural anesthesia varies from 15 to 20%. [1],[2] 14% of all epidural failures were due to technical reasons. [3] Checking the catheter integrity before placement prevents failure of epidural analgesia. Catheters can have manufacturing defects related to connector assembly, faulty marking, intraluminal obstructions, and tensile strength, which could lead to breaking of catheter during insertion or removal.

We want to highlight the need to check the catheter and the assembly by flushing before inserting as the standard of manufacturing is not always infallible. [4] Resistance in drug flow in catheters could be because of improper connection of catheter and injector assembly, [5] clot in the catheter, [6] kinking of catheter, knotting of catheter, [6] or manufacturing defect in catheter assembly/catheter itself. [7]

 
  References Top

1.Orbach Zinger S, Friedman L, Avramovich A, Ilgiaeva N, Orvieto R, Sulkes J, et al. Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for cesarean section. Acta Anaesthesiol Scand 2006;50:793-7.  Back to cited text no. 1
    
2.Beilin Y, Zahn J, Bernstein HH, Zucker-Pinchoff B, Zenzen W, Andres LA. Treatment of incomplete analgesia after placement of epidural catheter and administration of local anesthetic for women in labor. Anesthesiology 1998;88:1502-6.  Back to cited text no. 2
    
3.Ballantyne JC, Mc Kenna JM, Ryder E. Epidural analgesia- experience of 5628 patients in a large teaching institute derived through audit. Acute Pain 2003;4:89-97.  Back to cited text no. 3
    
4.Shirgoankar A, Russel IF. To check or not to check- that is the question? Anaesthesia 2008;63:677-8.  Back to cited text no. 4
    
5.Gupta S, Singh B, Kachru N. Blocked Epidural Catheter-Another Case. Anesth Analg 2001;92:1617-8.  Back to cited text no. 5
[PUBMED]    
6.Bajaj P, Raiger L, Raman V. Kinking of epidural catheter- A case report. Indian J Anaesth 2003;4:53-4.  Back to cited text no. 6
  Medknow Journal  
7.Lewis PR, Gagg CR. Failure of an epidural catheter. Eng Fail Anal 2009;16:1805-15.  Back to cited text no. 7
    


    Figures

  [Figure 1]



 

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