To the Editor:—
We wish to report the uncoiling and separation of the internal wire of a Flextip epidural catheter (Arrow International, Reading, PA) on removal. We placed a Flextip catheter into the L3–L4 interspace of a 14-yr-old gravida 1, 80-kg, 160-cm tall patient for labor analgesia using a 17-gauge Tuohy needle and the technique of loss of resistance to air. We attempted to introduce the epidural catheter, but it would not pass beyond the end of the needle. We then advanced the epidural needle approximately 1 mm in accordance with the directions supplied by the manufacturer and were then able to introduce the epidural catheter into the epidural space. The catheter was advanced 4 cm into the epidural space, and the needle was withdrawn. The epidural catheter functioned normally for labor analgesia. Subsequently, the local anesthetic infusion was discontinued, and the conduction block was allowed to recede. On removal of the catheter, there was considerable resistance to withdrawal. We asked the patient to flex her back to facilitate the removal of catheter. With increased flexion, we were able to withdraw the catheter. However, on continued attempts to withdraw, we realized that the plastic outer portion of the catheter had been removed from the patient’s back, but the wire was uncoiling and still within the patient. At this time, because the patient had good sensation and movement in all dermatomes where epidural analgesia had been present, we believed that it was acceptable to continue with gentle traction as long as there were no paresthesias during this procedure. The wire gradually was removed from the patient’s back with no symptoms or sequelae.
We believe this is the first report of the internal wire of an epidural catheter uncoiling within the patient’s back. This may pose risk to the patient because the sharp wire may increase the potential for internal lacerations. We examined the catheter and wire using a microscope and found that the plastic catheter appeared intact, but a sharp hook was present at the end of the wire (fig. 1)
Fig. 1. The catheter and part of the wire that uncoiled and was extended beyond the plastic portion of the catheter is shown. Note the sharp hook at the end of the wire.
Fig. 1. The catheter and part of the wire that uncoiled and was extended beyond the plastic portion of the catheter is shown. Note the sharp hook at the end of the wire.
Fig. 2. The catheter is shown with a 19-cm length of wire extending beyond the plastic portion of the epidural catheter.
Fig. 2. The catheter is shown with a 19-cm length of wire extending beyond the plastic portion of the epidural catheter.
shows the epidural catheter with 19 cm of the extended uncoiled wire.
The possibility exists that structures in the epidural space may be lacerated by the sharp wire during removal from the patient. This may increase the possibility of epidural hematoma. We removed the catheter after the block had resolved, and no symptoms were present at that time. In a recent case report, 1an epidural catheter fragment was retained after coiling around a nerve root. One can speculate that if an epidural catheter has coiled around a nerve root and also separates, as it did in our patient, injury to the nerve root may be more likely.
