[Knot on the epidural catheter, a rare complication: a case report]

Knot on the epidural catheter, a rare complication: a case report A 30-year 1-grava woman received an epidural for labor pain. Insertion was uncomplicated and she had an effective analgesia. The epidural was successfully converted to epidural anaesthesia for Caesarean section. The epidural was removed 24 hours thereafter. The mother was lying and trying to curve the back during removal. It was initially easy to pull but after some centimeters it became difficult. The mother was asked to curve further and pulling continued. The catheter came out with some constraints with a knot on the tip. The mother had no pain during traction. The subsequent course was uneventful. A knot on the epidural catheter is a rare complication to epidural analgesia/anaesthesia. There are several reviews giving advice how to avoid its occurrence and how to act if the catheter cannot be easily removed. It is advised to limit the length of catheter inserted into the epidural space; no more than 4-5 cm. If the catheter is not easily removed; »gentle and steady traction« is recommended with the patient initially in a position as similar as possible to the one during insertion. If it is still not possible to remove, an X-ray or MRI is suggested to confirm that there isn't any nerve involvement, followed by pulling firmly again until the catheter comes out or breaks. A broken catheter should »in general« be left in place unless symptoms occur.