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LETTER TO THE EDITOR

Editor's note: Due to a publisher's error, the following response by Amar et al. to the Letter to the Editor by Lohser and Brodsky published in the July 2008 issue (Anesth Analg 2008;107:342) was left out of the July issue. The publisher apologizes for the error.

Difficult Removal of an Arrow Flextip Plus^TM Epidural Catheter

Service d'anesthésie ambulatoire, CH de Blois, France (Chiron) Groupement d'anesthésie-réanimation, CHRU de Tours; Université François Rabelais, France; b.chiron{at}voila.fr (Mariaux de Serres, Fusciardi, Laffon)

To the Editor:

We report the inability to remove a wire reinforced epidural catheter and the proposed mechanism after epidural analgesia for labor. Epidural analgesia was performed in a patient in the right lateral position. A 19-gauge Arrow FlexTip Plus^TM epidural catheter was inserted without difficulty and accompanied by satisfactory analgesia. Two hours after delivery, an attempt to remove the catheter was unsuccessful. With the patient in the sitting position, and flexing her back, a second attempt at catheter removal was also unsuccessful, and an radiograph performed after injecting contrast into the catheter showed a simple loop in the catheter (Fig. 1). A third attempt to remove the catheter with the patient in the lateral position (initial position during the epidural puncture) was then successful. The catheter is composed of a spiral metal coil coated with a polyurethane sleeve but at the distal end the metal spiral is more flexible, which can explain the formation of a loop hindering removal1,2 (Fig. 2). Our report suggests that in this situation simple measures, previously cited: wait several hours to allow an optimal muscular relaxation in postpartum,3 withdrawing the catheter with the patient in position used during the epidural puncture or in lateral position because the forces necessary to withdraw a catheter were 2.5 less than in sitting position4,5 and injection of 3 mL of saline followed by a careful continuous traction6 might facilitate catheter removal.

View larger version (73K): [in this window] [in a new window]   Figure 1. Simple loop on the Arrow FlexTip PlusTM.

View larger version (154K): [in this window] [in a new window]   Figure 2. Structurally more flexible area of the catheter Arrow FlexTip PlusTM.

REFERENCES

1. Banwell BR, Morley-Forster P, Krause R. Decreased incidence of complications in parturients with the arrow (Flex Tip Plus) epidural catheter. Can J Anaesth 1998; 45:370–2[Web of Science][Medline]
2. Hopf H-B, Leischik M. More on problems with removing the arrow Flex Tip Epidural catheter: smooth in hardly out? Anesthesiology 2000;93:1362[Web of Science][Medline]
3. Pierre HL, Block BM, Wu CL. Difficult removal of a wire-reinforced epidural catheter. J Clin Anesth 2003;15:140–1[Web of Science][Medline]
4. Boey S, Carrie L. Withdrawal forces during removal of lumbar extradural catheters. Br J Anaesth 1994;73:833–5[Abstract/Free Full Text]
5. Morris GN, Warren BB, Hanson EW, Mazzeo FJ, DiBenedetto DJ. Influence of patient position on withdrawal forces during removal of lumbar extradural catheters. Br J Anaesthesia 1996;77:419–20[Abstract/Free Full Text]
6. Day C. Difficult removal of an epidural catheter. Anaesthesia 1993;48:448[Web of Science][Medline]

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