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Separation of stimulating catheters for continuous peripheral regional anesthesia during their removal - two case reports and a critical appraisal of the use of steel-coil containing stimulating catheters.

Wiesmann T, Wallot P, Nentwig L, Beermann AV, Wulf H, Zoremba M, Al-Dahna T, Eschbach D, Steinfeldt T - Local Reg Anesth (2015)

Bottom Line: Stimulating catheters are widely used for continuous peripheral nerve block techniques in regional anesthesia.The incidence of reported complications is somewhat similar to that for non-stimulating catheters.Anesthesiologists should strictly avoid catheter shearing during insertion, adhere to the manufacturer's instructions, and take care during catheter removal.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Intensive Care Medicine, University Hospital Marburg, Marburg, Germany.

ABSTRACT

Purpose: Stimulating catheters are widely used for continuous peripheral nerve block techniques in regional anesthesia. The incidence of reported complications is somewhat similar to that for non-stimulating catheters. However, as many stimulating catheters contain a coiled steel wire for optimal stimulation, they may cause specific complications.

Clinical features: In this report, we present two cases of complicated removals of stimulating catheters. During both removals, a part of the metal wire was left "decoiled" next to the supraclavicular and interscalene plexus, respectively. The strategies used to determine steel wire localization and a description of the successful removal of these steel wires are included in this report.

Conclusion: Catheter separation and problems with residual metal wire components of stimulating catheters seem to be a rare but specific problem during removal. Anesthesiologists should strictly avoid catheter shearing during insertion, adhere to the manufacturer's instructions, and take care during catheter removal. Manufacturers should focus on technical solutions to avoid rare but relevant complications such as catheter tip decoiling and separation of stimulating catheters during removal.

No MeSH data available.


Related in: MedlinePlus

Computed tomography scan (frontal view) of residual metal wire.
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f2-lra-8-015: Computed tomography scan (frontal view) of residual metal wire.

Mentions: In a second attempt, sterile saline 0.9% was injected via the indwelling intravenous catheter with the hope of removing suspected adhesions or resolving catheter kinking, “pigtailing” or coiling phenomena. However, this approach failed again. Sterile draping was applied and a computed tomography (CT) scan of the neck was scheduled to further investigate these complications. In the CT scan (see Figure 2), the residual wire was shown starting from beneath the skin lying backwards and ending next to the supraclavicular plexus (but not within the fascicles) without relevant kinking or coiling. Thereafter, our local ear, nose, and throat (ENT) specialists were consulted to discuss further options. After a thorough discussion of this topic with the orthopedic consultant, and within this framework, the patient gave consent for surgical removal by a neurosurgeon and an ENT surgeon who specializes in neck dissections, performed under general anesthesia. After the induction of general anesthesia and complete muscular relaxation in the afternoon, the ENT surgeon performed forceful traction again. The complete residual wire, including the complete characteristic steel wire tip, was successfully removed during this last attempt. Therefore, a surgical incision was not performed. After the termination of anesthesia, the patient had no neurological sequelae or pain at the insertion site or close to the plexus. She was discharged home on the following day.


Separation of stimulating catheters for continuous peripheral regional anesthesia during their removal - two case reports and a critical appraisal of the use of steel-coil containing stimulating catheters.

Wiesmann T, Wallot P, Nentwig L, Beermann AV, Wulf H, Zoremba M, Al-Dahna T, Eschbach D, Steinfeldt T - Local Reg Anesth (2015)

Computed tomography scan (frontal view) of residual metal wire.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492648&req=5

f2-lra-8-015: Computed tomography scan (frontal view) of residual metal wire.
Mentions: In a second attempt, sterile saline 0.9% was injected via the indwelling intravenous catheter with the hope of removing suspected adhesions or resolving catheter kinking, “pigtailing” or coiling phenomena. However, this approach failed again. Sterile draping was applied and a computed tomography (CT) scan of the neck was scheduled to further investigate these complications. In the CT scan (see Figure 2), the residual wire was shown starting from beneath the skin lying backwards and ending next to the supraclavicular plexus (but not within the fascicles) without relevant kinking or coiling. Thereafter, our local ear, nose, and throat (ENT) specialists were consulted to discuss further options. After a thorough discussion of this topic with the orthopedic consultant, and within this framework, the patient gave consent for surgical removal by a neurosurgeon and an ENT surgeon who specializes in neck dissections, performed under general anesthesia. After the induction of general anesthesia and complete muscular relaxation in the afternoon, the ENT surgeon performed forceful traction again. The complete residual wire, including the complete characteristic steel wire tip, was successfully removed during this last attempt. Therefore, a surgical incision was not performed. After the termination of anesthesia, the patient had no neurological sequelae or pain at the insertion site or close to the plexus. She was discharged home on the following day.

Bottom Line: Stimulating catheters are widely used for continuous peripheral nerve block techniques in regional anesthesia.The incidence of reported complications is somewhat similar to that for non-stimulating catheters.Anesthesiologists should strictly avoid catheter shearing during insertion, adhere to the manufacturer's instructions, and take care during catheter removal.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Intensive Care Medicine, University Hospital Marburg, Marburg, Germany.

ABSTRACT

Purpose: Stimulating catheters are widely used for continuous peripheral nerve block techniques in regional anesthesia. The incidence of reported complications is somewhat similar to that for non-stimulating catheters. However, as many stimulating catheters contain a coiled steel wire for optimal stimulation, they may cause specific complications.

Clinical features: In this report, we present two cases of complicated removals of stimulating catheters. During both removals, a part of the metal wire was left "decoiled" next to the supraclavicular and interscalene plexus, respectively. The strategies used to determine steel wire localization and a description of the successful removal of these steel wires are included in this report.

Conclusion: Catheter separation and problems with residual metal wire components of stimulating catheters seem to be a rare but specific problem during removal. Anesthesiologists should strictly avoid catheter shearing during insertion, adhere to the manufacturer's instructions, and take care during catheter removal. Manufacturers should focus on technical solutions to avoid rare but relevant complications such as catheter tip decoiling and separation of stimulating catheters during removal.

No MeSH data available.


Related in: MedlinePlus