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Migration of pediatric epidural catheters
Thomas Strandness1, Marisa Wiktor, Jaya Varadarajan
1Department of Pediatric Anesthesia, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
Background:
Postoperative pain control in the pediatric population frequently involves epidural catheters placed intraoperatively. A retrospective review of epidural catheter tip position was conducted by evaluation of routine chest anterior-posterior (A-P) X-rays obtained by the surgical and ICU teams.
Methods:
Of the 174 pediatric epidural catheters placed during a 1-year period at Children's Hospital of Wisconsin, 59 pediatric patients with chest X-rays demonstrating epidural catheter tip on at least 2 days were reviewed. The change in epidural catheter position was then calculated. The overall reason for discontinuation of epidural analgesia in the larger population was also compiled.
Results:
It was determined that epidural catheters migrated more frequently in patients <10 kg and 10-40 kg, when compared to those >40 kg P < 0.001. The average migration seen on X-ray was 1.1 levels inward in those <40 kg and 0.3 levels inward in those >40 kg. The incidence of catheters discontinued secondary to falling out, or migrating in, was also increased in those patients <40 kg when compared to those >40 kg.
Conclusion:
Results suggest that epidural catheters move inward more frequently and fall out more frequently in patients <40 kg.
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