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Case Reports
. 2014 Jul;8(3):424-7.
doi: 10.4103/1658-354X.136644.

A case report of a retained and knotted caudal catheter

Anita Joselyn  1 , Tarun Bhalla  1 , Brian Schloss  1 , David Martin  1 , Joseph Tobias  1
Affiliations
Case Reports

A case report of a retained and knotted caudal catheter

Anita Joselyn et al. Saudi J Anaesth. 2014 Jul.

Abstract

Caudal catheters advanced to the lumbar and thoracic regions can be used to provide excellent analgesia for pre-term neonates undergoing major abdominal and thoracic procedures. Despite their frequent use, attention to detail is mandatory to avoid complications related to the medications used or the placement technique. We present a 2-day-old, 2 kg, pre-term infant who was born at 32 weeks gestational age with a tracheoesophageal fistula. Following anesthetic induction, a caudal epidural catheter was placed with the intent of threading it to the mid-thoracic level. The intraoperative and post-operative courses were uneventful with the epidural catheter providing adequate analgesia without the need for supplemental intravenous opioids. During catheter removal, resistance was noted and it could not be easily removed. With repositioning and various other maneuvers, the catheter was removed with some difficulty. On examination of the catheter, a complete knot was noted. Options for catheter advancement from the caudal space to the thoracic dermatomes are reviewed and techniques discussed for removal of a retained epidural catheter.

Keywords: Knotted caudal catheter; pre-term neonate; retained caudal catheter.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Photograph demonstrating true knot in the distal end of caudal epidural catheter following removal. The tight wire coil that is within the catheter has been stretched during removal
Figure 2
Figure 2
Radiograph demonstrating that the caudal epidural catheter has doubled back on itself in the epidural space, forming a loop with the potential for knot formation
See this image and copyright information in PMC

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