In Reply:—

Dr. Woehlck’s concern for the possibility of the wire lacerating structures in the epidural space during removal is the first of its kind to be reported to Arrow International, Inc. Based on Arrow’s experience with the FlexTip Plus, there have been no reported incidents of lacerations from the wire. The clinical advantages of the FlexTip Plus is that it is softer than conventional catheters and has been proven to reduce indwelling complications.

The outer surface of the FlexTip Plus is a very soft polyurethane material. This softness offers many clinical advantages; however, occasionally users encounter a catheter that is more difficult to remove and requires extra care. Familiarizing oneself with the properties of the FlexTip Plus and specific removal techniques will allow the catheter use to be uneventful, even in a situation in which the catheter at first appears to be difficult to remove.

The FlexTip Plus is extremely strong and can withstand significant stretching, but it is not unbreakable. New users should acclimate themselves with the catheter’s elongation properties and break point. Resistance is a signal that the patient’s anatomy is applying atypical force to the indwelling portion of the catheter. If the catheter cannot be withdrawn with minimal force, Arrow recommends considering the following options:

1. Reposition the patient and/or allow the patient to relax for several minutes/hours and attempt removal later. Studies have proven that the force required to remove an epidural catheter can vary dramatically depending on patient positioning. Arrow recommends that the patient be placed in the same position for removal as they were for placement.

2. Some users have found that injecting a small bolus of saline or positive pressure with air while removing the catheter has helped. These techniques are documented in the literature. 1 

3. Finally, in conjunction with suggestion no. 1, several users have described how they successfully stretched the catheter slightly and taped it to the skin, thus creating permanent tension on the catheter. As the patient relaxes and moves, the forces holding the indwelling portion of the catheter diminish, and the tension on the catheter (created by stretching and taping) cause it to automatically retract from the epidural space. Depending on the length of catheter indwelling and how much the catheter is stretched before taping it down, following this procedure should make the catheter easier to remove. This technique may be repeated if necessary.

Under no circumstance should extreme force be applied to the catheter during removal. We also recommend a review of the current literature, because alternative techniques have been published.

We strongly believe that the FlexTip Plus is associated with far fewer indwelling complications than standard epidural catheters and that this occurrence is rare compared with the number of catheters sold.

Gadalla F: Removal of a tenacious epidural catheter (letter). Anesth Analg 1992; 75:1070