Epiphany anesthesia, catheter rupture in the patient's body, how to do?

Clinicalthe epidural catheter softened in anesthesia for continuous epidural anesthesia or postoperative analgesia, and in the course of practice, catheter removal difficulties, even breaks in the body occur from time to time, to medical staff and patients are very troubled, but also easy to cause medical disputespreoperative preparation, sudden catheter rupturepatients, female, 27 years old, the obstetrics to perform painless deliveryafterthe patient's family signature, enter the delivery room, the conventional epidural anaesthetic puncture pre-preparation, put the right position, disinfection by L3, 4 puncture to the epidural cavity, placed in the epidural outer catheter, pull out the puncture needle found that the epidural outside catheter rupture, about 6.1cm long, timely report to the superior doctor and the director of the departmentAnd after the incident to inform the family, and actively communicate with the patient's family to discuss possible results and treatment of comments and recommendationscommunicates with the patient's family, the patient's family requested that the ruptured epidural catheter be removed in January after the birthclinicaltreatment after:patients in the month after the birth of orthopaedics, timely lumbar CT examination, to find the epidural cavity retention catheter, as shown in Figure 1, 2, 3Figure 1 CT examination image resultsFigure 2 Image results indicate epidural residual catheter morphology
Figure 3 CT results of the epidural residual catheter location indicationcoordinated with the relevant departments, the patient was given the intervertebral mirror downdural epidural rupture catheter removalFinally, through the epidural outer cavity L3-4 clearance smoothly removed the fractured epidural tube, about 6.1 cm long, the length is complete to give anti-inflammatory anti-semam support treatment, the patient has been successfully discharged from the hospital, no related complications after surgery Why does catheter break? generally, the probability of conduit break spawning during epidural anesthesia surgery in obstetrics and gynecology is relatively high, and the maximum peri-unduroral catheter fracture can reach 15-16cm the rupture of the epidural catheter can not only occur in the puncture tube, but also can occur when the tube is pulled after surgery, anesthesiologists, especially in primary hospitals or young doctors with less clinical experience should raise awareness and vigilance There are many causes of clinical catheter fracture, mostly related to the operation of anesthesiologists, pathological or physiological changes in the puncture area, and catheter factors tube when the catheter break is mainly associated with the catheter placed too deep (.5cm), the tube encounter and resistance, the pipe recoil (adjustment) operation Tuohy needle does not fit the movement, the Tuohy needle in the epidural gap position, the catheter is located at the tip of the needle and the bone surface or stuck into the vertebrae joint or bone seam ; What should I do if i a catheter break? because the material of the epidural cavity catheter is a biological material that has been verified by clinical safety experiments, in general, the body biomaterial foreign material can be identified by the immune system, with the residual foreign body as the center to form immune compound package, does not cause abnormal neurostimulation symptoms and foreign body stress response, so no clinical symptoms of patients do not need special treatment, can be temporarily clinicalobservation after all, if the fracture catheter is forcibly removed, it may damage the spinal tri-zone and three-pillar structure associated with the puncture site, causing lumbar instability However, for patients left in the catheter body, a certain examination (in vitro residual catheter and imaging examination) and body examination to understand the length of the remaining catheter in the patient and to assess the exact location of the catheter (intra-vertebral/outer) to the maximum possible studies have shown that CT flat sweep scans have a higher resolution than X-ray tubes, and x-rays can be a clinical preference if CT tests are not immediately performed if the preliminary assessment of the fracture catheter is located outside the vertebral tube, the catheter can be removed as far as possible by local incision, and if the fractured catheter is located in the vertebral tube, the pros and cons will be weighed by the surgeon How can avoid catheter breaks? for the special complication of catheter fracture, we can avoid from the following aspects to avoid: , in the hard endometriosis puncture tube difficulties, pay attention to the epidural outside the catheter and puncture needle together to remove, and check that the epidural tube is not defective break; and epidural external blocking puncture tube, if you can choose the reinforced epidural outer catheter is used, because it improves the sharpness of the epithelial gap of the epidural needle, can avoid the occurrence of fracture ; , at the end of the operation to remove the epidural catheter, can not force a quick pull with force, if the failure to pull the tube can tell the patient to return to the pre-piercing position to remove the catheter, if necessary, in the deep vein puncture needle guide to remove the epidural catheter; , the appearance of the catheter residual body need not panic, To master the relevant knowledge and clinical vertebral tube foreign body diagnosis and treatment process, to minimize medical risks Multi-Team Source: Main Knife Forum Great Review: Song 2020-2-3 Review: learned a very useful (from: MedSci Medical APP )