Epidural abscess and meningitis are rare but serious complications subsequent to epidural catheter placement. There are a number of different methods for preventing these infections.
After we experienced a case of epidural abscess related to epidural catheterization in September 2002, we changed procedures for preventing catheter infection during continuous epidural block. The modified procedures include scrubbing the site for insertion using chlorhexidine in ethanol and/or povidone iodine every 2 to 3 days, applying a small patch containing chlorhexidine (Biopatch^®), using patient-controlled analgesia (PCA) devices for all patients, and allowing only anesthetists or nurses in the pain management department to prepare the infusion solutions.
We evaluated the effectiveness of these procedures by comparing the incidence of catheter infection over the one-year period before implementing the modified procedures with that after implementing the modified procedures, retrospectively.
We also checked the patients' age, gender, duration of catheterization, the site of insertion, and the cause of cessation of catheterization during both periods.
Although 13 of the 65 patients who received the pre-modified infection-preventive procedures during epidural catheterization suffered catheter-related infection, none of the 35 patients who received the modified procedures suffered infection. The incidence of catheter-related infection was significantly lower using the modified procedures compared to that using the pre-modified procedures.
In conclusion, our modified infection-preventive procedures, which include using PCA devices, applying Biopatch^®, and preparing infusate only by the pain management department staff, minimize the risk of infection-related complications during epidural catheterization.