To the Editor
I was interested to read the review article in the winter issue of the APSF Newsletter on epidural anesthesia and in particular the discussion on the management of the disconnected catheter. I was concerned by the reviewers’ conclusion that it was probably safe to reconnect a disconnected epidural catheter on the proviso that at least eight inches of the catheter were cut off under sterile conditions and that the cut end was treated with betadine. This conclusion was reportedly based on the findings of a study by Langevin and Gravenstein. The abstract (1) of the quoted study, however, states that fluid movement in a contaminated epidural catheter may lead to extensive contamination of the catheter. This would seem to preclude any consideration of reconnecting such a catheter. Moreover, it has been shown that following a similar decontamination procedure, intentionally contaminated epidural catheters show a significant incidence of residual contamination. (2)
The most prudent course of action to prevent catheter related infections is to select an epidural catheter hub/connector with the least likelihood of disconnection, to take all precautions to prevent disconnection, (3) and to remove or replace any catheters that become disconnected.’ Any recommendation to the contrary is ‘probably’ not in the best interest of patient safety.
Robin J. Gavelin, M.D., FRCPC Assistant Professor, Director, Acute Pain Service
University of Texas Medical Branch Galveston, TX
- Langevin PB, Gravenstein N. Epidural catheter contamination: effect of catheter position and meniscus on extent of contamination. Anesthesiology 77(3A); A1041, 1992.
- Royal MA, Sutherland RM. A study of potential contamination rates with epidural catheter hub disconnections. Regional Anesthesia 18(25) ; 42,1993.
- Gavelin RJ, Patterson K. Epidural catheter disconnections. Can J Anaesth 40(5); 468,1993.
- Litwick K, Lubenow T. Practical points in the management of continuous epidural infusions. journal of Post Anesthesia Nursing 4; 327-30,1989.