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Kansai Medical University, Moriguchi City, Osaka, Japan, asait{at}takii.kmu.ac.jp
To the Editor:
The Arrow FlexTip PlusTM epidural catheter (Arrow International, Reading, PA) is associated with less paresthesia or penetration of epidural veins than conventional catheters (1). Nevertheless, it can be difficult to remove (2–5). We report a case of difficult removal, with a new solution.
A 31-yr-old woman (161 cm, 58 kg) at 14 wk of pregnancy, was scheduled for oophorectomy. With the patient in the right decubitus position, a 19-gauge Arrow FlexTip PlusTM catheter was placed in the L2-3 epidural space via a median approach and threaded so that the distal 5 cm resided in the epidural space. The needle was removed, and attempts were made to withdraw the catheter for 1–2 cm, which proved impossible. Nevertheless, effective analgesia was obtained during and after surgery.
Two days later the catheter still could not be removed despite changing patient position. We elected to not obtain a radiograph to document the catheter location because the patient was pregnant. We gently stretched the catheter and taped it to the skin to give continuous tension to the catheter (as the manufacturer states in the information sheet) and encouraged the patient to walk about and move her back. This did not remove the catheter. Instead, the catheter was stretched and the segment between the 7- and 8-cm marks was partially disrupted, with exposure of a small segment of the inner metal coil. We elected to remove the catheter by making a small skin incision around the catheter (under local anesthesia), followed by grasping the catheter at the 6-cm mark with forceps. While applying a steady tension to the catheter, we encouraged the patient to twist her hip in different directions. The catheter was finally removed without breakage.
Our previous ex vivo study has shown that the Arrow FlexTipTM epidural catheter is more likely to stretch and break than conventional catheters (2) and that the segment between the 7- and 8-cm marks, where the density of the inner metal coil changes and where an intact catheter makes a natural curve, is vulnerable to breakage (2). If it is impossible to remove the Arrow FlexTip PlusTM epidural catheter after several different methods, it may be useful to make another attempt at removal by gripping the catheter between the tip and 7-cm segment.
References
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