Subarachnoid lumbar drains: A case series of fractured catheters and a near miss |
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Authors: | Hernando Olivar John S Bramhall Irene Rozet Monica S Vavilala Michael J Souter Lorri A Lee Arthur M Lam |
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Institution: | Department of Anesthesiology Harborview Medical Center, University of Washington, Seattle, WA 98104, USA. olivarh@u.washington.edu |
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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. |
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