Abstract
Purpose
Lumbar subarachnoid catheters for cerebrospinal fluid (CSF) drainage (lumbar drains) are indicated for several medical and surgical conditions. A number of complications can occur from the placement of this type of catheter, including catheter breakage from excessive traction or shearing over the Tuohy needle.
Clinical features
Five cases of lumbar subarachnoid catheter breakage/shearing and catheter fragment retention, as well as one near miss, were identified over a one-year period at a single institution. All (n = 6) patients were undergoing neurosurgical procedures. Four patients required surgical retrieval of the catheter fragments. No patient experienced log-term neurological sequelae.
Discussion
From these experiences, the following risks factors for catheter rupture are identified: 1) intentional or accidental retraction of the catheter through the needle during placement; 2) faulty use of the guidewire; or 3) use of excessive force during removal of the catheter. Methods to prevent such complications are suggested, including minimal use, or complete avoidance of a guidewire.
Résumé
Objectif
Les cathéters lombaires sous-arachnoïdiens pour le drainage (drains lombaires) du liquide céphalorachidien (LCR) sont indiqués pour de nombreuses conditions médicales et chirurgicales. Un nombre de complications peut survenir lors du positionnement de ce type de cathéter, y compris un bris de cathéter dû à une traction excessive ou à un cisaillement de l’aiguille Tuohy.
Éléments cliniques
Cinq cas de brisldsaillement de cathéter lombaire sous-arachnoïdien et de rétention de fragment de cathéter, ainsi qu’un « near miss», ont été identifiés au cours d’une période d’une année dans une seule institution. Tous les patients (n = 6) subissaient des procédures neurochirurgicales. Quatre patients ont nécessité une récupération chirurgicale des fragments de cathéter. Aucun patient n’a souffert de séquelles neurologiques a long terme.
Discussion
Nous avons pu identifier les facteurs de risque suiv-ants pour le bris de cathéter suite à ces expériences : 1) rétraction intentionnelle ou accidentelle du cathéter à travers l’aiguille pendant le positionnement; 2) mauvais usage du fil guide; ou 3) utilisation de force excessive pendant l’extraction du cathéter. Certaines méthodes afin de prévenir de telles complications sont suggérées, y compris une utilisation minimale, voire nulle, du fil guide.
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Olivar, H., Bramhall, J.S., Rozet, I. et al. Subarachnoid lumbar drains: A case series of fractured catheters and a near miss. Can J Anesth 54, 829–834 (2007). https://doi.org/10.1007/BF03021711
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DOI: https://doi.org/10.1007/BF03021711