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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.
Insights
Pediatric epidural catheters migrated more often in patients under 40 kg, leading to increased dislodgement. This highlights the need for closer monitoring of epidural catheter placement in smaller pediatric patients.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Postoperative pain management in children often utilizes epidural catheters.
- Epidural catheter tip position is typically assessed via intraoperative anterior-posterior (A-P) chest X-rays.
Purpose of the Study:
- To retrospectively review epidural catheter tip position in pediatric patients.
- To evaluate the change in epidural catheter position over time.
- To determine factors influencing epidural catheter migration and discontinuation.
Main Methods:
- Retrospective review of 59 pediatric patients with epidural catheters over a 1-year period.
- Analysis of anterior-posterior (A-P) chest X-rays to assess catheter tip position on at least two separate days.
- Calculation of epidural catheter migration and compilation of reasons for discontinuation.
Main Results:
- Epidural catheters migrated more frequently in pediatric patients weighing less than 40 kg compared to those over 40 kg (P < 0.001).
- Average inward migration was 1.1 levels in patients <40 kg versus 0.3 levels in patients >40 kg.
- Higher incidence of catheter discontinuation due to dislodgement or migration was observed in patients <40 kg.
Conclusions:
- Epidural catheters demonstrate increased inward migration in pediatric patients weighing less than 40 kg.
- Catheter dislodgement and migration are more frequent in smaller pediatric patients (<40 kg).
- Findings suggest a need for enhanced monitoring of epidural catheter placement in this demographic.
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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