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Intrathecal Catheter Puncturing Followed by a Pocket Fill After a Pump Refill: A Case Report and Review of the
Andrea Tinnirello1, Carola Santi2
1Anesthesia and Pain Management unit ASST Franciacorta-Chiari (BS) Italy.
Background:
Refilling intrathecal drug delivery systems is a delicate procedure that can lead to serious complications. We report the first case of catheter damage during a refill.
Case Report:
A patient implanted with a 20-mL reservoir pump for intrathecal baclofen infusion for severe spasticity complained of spasticity increase after a complex refill. Despite increasing the drug dosage, the patient's symptoms did not improve, and, after another refill, he was hospitalized for deep sedation and unresponsiveness.
Abstract:
Surgical revision demonstrated a catheter lesion close to the connection with the pump reservoir.
Abstract:
We hypothesize that the catheter had been lesioned during the first refill and, after the last refill, a pocket fill occurred with a significant dose of baclofen reaching the intrathecal space.
Conclusion:
Ultrasound or fluoroscopic guidance should be used when performing challenging pump refills to avoid potentially catastrophic adverse events such as catheter lesions or pocket fills.
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