Visualization of a looped and knotted epidural catheter with a guidewire
Visualization of a looped and knotted epidural catheter with a guidewire
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DOI：
10.1007/bf03020947
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发表时间：
2000-04-01
期刊：
影响因子：
--
通讯作者：
Chow, D
中科院分区：
文献类型：
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作者：
Renehan, EM;Peterson, RA;Chow, D
目的：描述了一个环形和打结硬膜外导管分娩镇痛后的管理和deliveryClinical特征：产科硬膜外疼痛缓解提供了一个37岁的妇女在早期分娩。在L2 - L3间隙处插入20号Portex（R）导管，在硬膜外腔中留下6厘米的导管。阴道分娩后，无法取出导管。导管留在原位24小时。多次尝试取出导管均未成功。硬膜外导管在X线透视下不可见，无法将不透射线染料注入导管。然而，我们成功地将0.016英寸导丝推进通过硬膜外导管，并在放射学上显示了一个结和一个环的一部分。由骨科医生使用钝性解剖局部麻醉下从软组织只是侧面的棘间ligaments.Conclusions：一个结可以是一个罕见的原因被困硬膜外导管。一个建议的方法来捕获腰椎硬膜外导管：1）轻轻牵引导管与患者在不同的位置和不同程度的腰椎屈曲。2)通过导管注入无菌、无防腐剂的生理盐水，检测导管通畅性。3)放射学成像，以确定是否存在结并确定其位置，对于通畅导管使用不透射线造影剂或对于闭塞导管使用导丝。4)确定性治疗的方法是基于结的位置。这可以从局部麻醉下切除到外科专科会诊以进行更具侵入性的取出。
Purpose: To describe the management of a looped and knotted epidural catheter after analgesia for labour and deliveryClinical Features: Obstetrical epidural pain relief was provided for a 37-yr old woman in early labour. A 20-gauge Portex(R) catheter was inserted at the L2 - L3 interspace, Six centimetres of catheter was left in the epidural space. After vaginal delivery the catheter could not be removed. The catheter was left in situ for 24 hr. Repeated attempts at removal were again unsuccessful. The epidural catheter was not visible with fluoroscopy and it was impossible to inject radiopaque dye into the catheter. However, we successfully advanced a 0.016 inch guidewire through the epidural catheter and radiologically demonstrated a knot and part of a loop. The catheter was removed by an orthopedic surgeon using blunt dissection under local anesthetic from the soft tissue just lateral to the interspinous ligament.Conclusions: A knot can be a rare cause of a trapped epidural catheter. A suggested approach to the trapped lumbar epidural catheter: 1) Gentle traction on the catheter with the patient in various positions and in various degrees of lumbar flexion. 2) Test for catheter patency by injecting sterile, preservative-free normal saline through the catheter. 3) Radiological imaging to determine if a knot is present and to determine its location, using radiopaque contrast for patent catheters or a guidewire for occluded catheters. 4) The approach to definitive management is based on the position of the knot. This can range from excision under local anesthetic to consultation with a surgical specialty for more invasive retrieval.