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The Migration of Caudally Threaded Thoracic Epidural Catheters in Neonates and Infants

Allan F Simpao1, Jorge A Gálvez1, Elicia C Wartman2

  • 1From the Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Anesthesia and Analgesia
|February 27, 2018
PubMed

Insights

Pediatric epidural catheter migration is common in neonates and infants. Postoperative imaging is vital to ensure correct catheter tip placement for effective pain management.

Area of Science:

  • Pediatric Anesthesiology
  • Pain Management
  • Medical Device Safety

Background:

  • Thoracic epidural catheters are used for pediatric pain management.
  • Catheter migration is a known complication, but data in neonates and infants is limited.

Purpose of the Study:

  • To assess the incidence and extent of epidural catheter migration in neonates and infants.
  • To identify factors associated with catheter migration.

Main Methods:

  • Retrospective analysis of anesthesia records and diagnostic imaging.
  • Review of 85 neonates and infants (1-325 days old) with caudal epidural catheters.
  • Evaluation of catheter tip position changes on imaging studies.

Main Results:

  • 64% of patients experienced catheter migration (1+ vertebral levels).
  • 27% migrated to the T4 level or higher.
  • Significant migration (2+ levels) occurred in infants <6 kg and <73 days old.

Conclusions:

  • Epidural catheter migration is frequent in young children.
  • Postoperative imaging is essential to verify catheter position.
  • Failure to assess migration may lead to inadequate pain relief or adverse events.
Abstract

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