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Case Report
Knot Formation at Removal of an Epidural Catheter Placed Against Insertion Resistance Encountered at the Entrance of the Epidural Space - Byung Tae Kil, Bong Il Kim, Jong Hae Kim
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Kosin Medical Journal 2016;31(2):184-190.
DOI: https://doi.org/10.7180/kmj.2016.31.2.184
Published online: January 20, 2016
Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea
- Corresponding Author: Jong Hae Kim, Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea TEL: +82-53-650-4979 FAX: +82-53-650-4517 E-mail: usmed@cu.ac.kr
• Received: August 13, 2015 • Accepted: September 16, 2015
Copyright © 2016 Kosin University School of Medicine Proceedings
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract
- Knotting of an epidural catheter occurs very rarely with an estimated incidence of 0.0015%. We present a case of an epidural catheter knot formed at removal of an epidural catheter following a forceful insertion of the catheter against resistance met at the entrance of the epidural space during threading of the catheter through Tuohy needle placed uneventfully in a 65 year-old male patient undergoing epidural anesthesia. During removal of the epidural catheter, significant resistance was encountered on traction and it was found that approximately 1.5 ㎝ portion of the catheter had been retained within the patient's subcutaneous tissue. Firm traction was employed to withdraw the catheter against the resistance. The catheter was pulled out uneventfully from the patient. A knot estimated to be formed during removal of the catheter was observed at 0.6 ㎝ proximal to the catheter tip. No complications and side effects were noted until the patient's discharge.
Fig. 1.A knot of the epidural catheter is observed at 0.6 cm proximal to the catheter tip (red circle).
Fig. 2.The magnified view of the knot under a light microscope shows a reduced diameter of the epidural catheter proximal to the knot due to a significant tension against resistance encountered during removal of the catheter and a small amount of blood presumably from an epidural vein injured from forceful placement of the epidural catheter despite resistance upon insertion of the catheter into the epidural space.
- 1. McGregor PJ. In reply. Anesthesiology 1990;73:1293.PubMed
- 2. Brichant JF, Bonhomme V, Hans P. On knots in epidural catheters: A case report and a review of the literature. Int J Obstet Anesth 2006;15:159–62.ArticlePubMed
- 3. Aslanidis T, Fileli A, Pyrgos P. Management and visualization of a kinked epidural catheter. Hippokratia 2010;14:294–6.PubMedPMC
- 4. Singh V, Bhakta P, Ahuja A. Epidural catheter knot immediately after catheter insertion. Anaesth Intensive Care 2015;43:280–1.
- 5. Sexton AJ. Double kinking of a thoracic catheter within the epidural space. Anaesth Intensive Care 2012;40:732–3.PubMed
- 6. Fibuch EE, McNitt JD, Cussen T. Knotting of the theracath after an uneventful epidural insertion for cesarean delivery. Anesthesiology 1990;73:1293.ArticlePubMed
- 7. Chang PY, Hu J, Lin YT, Chan KH, Tsou MY. Butterfly-like knotting of a lumbar epidural catheter. Acta Anaesthesiol Taiwan 2010;48:45–8.ArticlePubMed
- 8. Gabopoulou Z, Mavrommati P, Chatzieleftheriou A, Vrettou V, Konstandinidou M, Velmachou K. Epidural catheter entrapment caused by a double knot after combined spinal-epidural anesthesia. Reg Anesth Pain Med 2005;30:588–9.ArticlePubMed
- 9. Dam-Hieu P, Rodriguez V, De Cazes Y, Quinio B. Computed tomography images of entrapped epidural catheter. Reg Anesth Pain Med 2002;27:517–9.ArticlePubMed
- 10. Lee CS, Kim SW, Shin JH, Park SY, Lee SC. Ultrasound-guided removal of epidural catheter breakage after percutaneous epidural neuroplasty. Anesth Pain Med 2011;6:321–4.
- 11. Boey SK, Carrie LE. Withdrawal forces during removal of lumbar extradural catheters. Br J Anaesth 1994;73:833–5.ArticlePubMed
- 12. Benzon HT, McCarthy RJ, Benzon HA, Kendall MC, Robak S, Lindholm PF, et al. Determination of residual antiplatelet activity of clopidogrel before neuraxial injections. Br J Anaesth 2011;107:966–71.ArticlePubMed
- 13. Mehran R, Baber U, Steg PG, Ariti C, Weisz G, Witzenbichler B, et al. Cessation of dual antiplatelet treatment and cardiac events after percutaneous coronary intervention (PARIS): 2 year results from a prospective observational study. Lancet 2013;382:1714–22.ArticlePubMed
- 14. Chassot PG, Delabays A, Spahn DR. Perioperative antiplatelet therapy: The case for continuing therapy in patients at risk of myocardial infarction. Br J Anaesth 2007;99:316–28.ArticlePubMed
- 15. Bateman BT, Mhyre JM, Ehrenfeld J, Kheterpal S, Abbey KR, Argalious M, et al. The risk and outcomes of epidural hematomas after perioperative and obstetric epidural catheterization: A report from the multicenter perioperative outcomes group research consortium. Anesth Analg 2013;116:1380–5.PubMed
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