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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

Catheter tip (Stimucath, Teleflex Germany, Kernen, Germany).
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f3-lra-8-015: Catheter tip (Stimucath, Teleflex Germany, Kernen, Germany).

Mentions: Finally, the specific wound metal tip (see Figure 3) might be more vulnerable to entangling with surrounding fascia structures (eg, prevertebral fascia, scalenus muscle fascia) compared with the smooth polyurethane tips on non-stimulating catheters. This might increase the risk of catheter separation with the application of gentle traction during removal. Interestingly, the majority of case reports with this catheter model deal with interscalene or supraclavicular nerve blockade. One might speculate as to whether this complication is seen more often in these locations or if it is due to the fact that interscalene catheter techniques are more common than continuous sciatic or femoral nerve blockades. On the other hand, postoperative mobilization might result in more catheter shearing stress in upper extremity compared with lower extremity nerve blocks, resulting in a predisposition for this complication.


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)

Catheter tip (Stimucath, Teleflex Germany, Kernen, Germany).
© Copyright Policy
Related In: Results  -  Collection

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

f3-lra-8-015: Catheter tip (Stimucath, Teleflex Germany, Kernen, Germany).
Mentions: Finally, the specific wound metal tip (see Figure 3) might be more vulnerable to entangling with surrounding fascia structures (eg, prevertebral fascia, scalenus muscle fascia) compared with the smooth polyurethane tips on non-stimulating catheters. This might increase the risk of catheter separation with the application of gentle traction during removal. Interestingly, the majority of case reports with this catheter model deal with interscalene or supraclavicular nerve blockade. One might speculate as to whether this complication is seen more often in these locations or if it is due to the fact that interscalene catheter techniques are more common than continuous sciatic or femoral nerve blockades. On the other hand, postoperative mobilization might result in more catheter shearing stress in upper extremity compared with lower extremity nerve blocks, resulting in a predisposition for this complication.

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