Rarely, an epidural catheter becomes impacted, causing difficulty upon withdrawal from the patient. Such difficulty has been attributed to “kinking, curling, coiling, knotting and looping” of the epidural catheter in the epidural space1 or entrapment in muscle, ligaments, joints, or bony structures.2,3 If multiple attempts at withdrawal by gentle traction in multiple patient positions is unsuccessful or if the catheter becomes disrupted, leaving a distal fragment in the patient, the impacted epidural catheter should be evaluated by neuraxial imaging1 using computerized tomography (Supplemental Digital Content 1, http://links.lww.com/ALN/B932), magnetic resonance imaging (if there is no metal in the epidural catheter), plain radiography, and/or ultrasonography to determine the mechanism of impaction. A three-dimensional multidetector computerized tomography reconstruction with color enhancement (panel A; Supplemental Digital Content 1, http://links.lww.com/ALN/B932) provides additional spatial information not seen with traditional computerized tomography imaging (panel B), thereby facilitating localization and visualization of the entire length of the retained distal epidural catheter fragment to enhance diagnostic evaluation and guide clinical management.
An impacted but completely buried length of epidural catheter can be managed conservatively with agreement of the asymptomatic patient. Before discharge, the patient should be given a written description of the insertion and attempts at withdrawal of the epidural catheter, the length and location of the impacted epidural catheter, along with copies of pertinent images; all to be shared with physicians (e.g., anesthesiologists, radiologists, surgeons) during any future medical care. Surgical retrieval is indicated when symptoms (e.g., bleeding, infection, pressure effects) are present, if an impacted length of epidural catheter protrudes from the patient’s skin, or at the insistence of the patient. (Supplemental Digital Content 2, http://links.lww.com/ALN/B933.)
The authors declare no competing interests.