Kosin Med J.  2016 Dec;31(2):184-190. 10.7180/kmj.2016.31.2.184.

Knot Formation at Removal of an Epidural Catheter Placed Against Insertion Resistance Encountered at the Entrance of the Epidural Space

• Kil BT
• Kim BI
• Kim JH

• KMID: 2365244
• DOI: http://doi.org/10.7180/kmj.2016.31.2.184

Abstract

Knotting of an epidural catheter occurs very rarely with an estimated incidence of 0.0015%. We present a case of an epidural catheter knot formed at removal of an epidural catheter following a forceful insertion of the catheter against resistance met at the entrance of the epidural space during threading of the catheter through Tuohy needle placed uneventfully in a 65 year-old male patient undergoing epidural anesthesia. During removal of the epidural catheter, significant resistance was encountered on traction and it was found that approximately 1.5 cm portion of the catheter had been retained within the patient's subcutaneous tissue. Firm traction was employed to withdraw the catheter against the resistance. The catheter was pulled out uneventfully from the patient. A knot estimated to be formed during removal of the catheter was observed at 0.6 cm proximal to the catheter tip. No complications and side effects were noted until the patient's discharge.

Keyword

Catheters; Epidural anesthesia; Postoperative complications; Traction

MeSH Terms

Anesthesia, Epidural
Catheters*
Epidural Space*
Humans
Incidence
Male
Needles
Postoperative Complications
Subcutaneous Tissue
Traction

Figure

• 

  Fig. 1. A knot of the epidural catheter is observed at 0.6 cm proximal to the catheter tip (red circle).

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  Fig. 2. The magnified view of the knot under a light microscope shows a reduced diameter of the epidural catheter proximal to the knot due to a significant tension against resistance encountered during removal of the catheter and a small amount of blood presumably from an epidural vein injured from forceful placement of the epidural catheter despite resistance upon insertion of the catheter into the epidural space.

Reference

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