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LETTERS TO EDITOR
Year : 2018  |  Volume : 12  |  Issue : 4  |  Page : 646-647

Crack in the epidural catheter filter port


1 Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, Bihar, India
2 Department of Anaesthesia, IGIMS, Patna, Bihar, India

Correspondence Address:
Dr. Neeraj Kumar
Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.SJA_165_18

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Date of Web Publication4-Oct-2018
 


How to cite this article:
Kumar N, Kumar A, Dubey PK. Crack in the epidural catheter filter port. Saudi J Anaesth 2018;12:646-7

How to cite this URL:
Kumar N, Kumar A, Dubey PK. Crack in the epidural catheter filter port. Saudi J Anaesth [serial online] 2018 [cited 2018 Dec 18];12:646-7. Available from: http://www.saudija.org/text.asp?2018/12/4/646/242642



Sir,

Disconnection of epidural catheter and filter is not unknown.[1] However, damage to the injection port of the epidural catheter filter is uncommon. We encountered such a problem during the use of an epidural catheter set for postoperative pain relief.

A 68-year-old man posted for right total knee replacement for which lumbar epidural catheter (B. Braun Melsungen AG, Melsungen, Germany) was placed at L3–L4 space through the midline approach. The catheter assembly was used uneventfully for the initial 48 h while the patient received intermittent top-up doses of bupivacaine and morphine mixture. After 72 h, we witnessed slight leakage of the analgesic solution from injection port of the epidural catheter filter during injection of the top-up dose [Figure 1]a. On closer evaluation, we noticed that there was a crack in the catheter filter port leading to the spillage.
Figure 1: (a) Epidural Filter Hub Crack. (b) Different nozzle diameters of 10-ml syringes of different makes

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While investigating the possible cause of this occurrence, we came to know that different brands of disposable 10-ml syringes are supplied to our hospital. On closer observation, we also noticed that there exists slight difference in nozzle diameter of these syringes [Figure 1]b. We suspect use of a syringe with a slightly larger diameter might have led to the damage to injection port of epidural filter. We inadvertently try to snugly fit the syringe nozzle into the injection port of the catheter filter applying excessive force. We speculate that such an attempt might have contributed to the damage and the consequent leakage of medication. If gone unnoticed, such a spillage might cause inadequate pain relief and patient dissatisfaction, apart from creating other problems.

Although this event shows a lack of regulatory standardization, we suggest keeping in mind this unusual complication while administering the epidural top-up doses. Gentle application of syringe in the filter port and looking for any leakage during drug administration should be practiced. Another possible solution is use of syringes and epidural set of the same manufacturer to avoid these types of problems.

Written consent for publication was obtained by the patient.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Donnelly T, Djabaty E, Davies M. Management of disconnection between epidural filters and catheters: A dilemma for the anaesthetist. Anaesthesia 2000;55:192-3.  Back to cited text no. 1
    


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