A Clinical Audit on Technical Difficulties during Epidural Catheter Placement UC11-UC14
Dr. Nitin Choudhary,
Flat No. F/2, Plot No. 853, Vaishali, Sector-5, Ghaziabad-201010, Uttar Pradesh, India.
Introduction: Epidural catheter placement is a routinely performed invasive procedure conducted by anaesthesiologist’s world over. A functional epidural catheter improves, not only the quality of anaesthesia but also patient satisfaction. Placing an epidural catheter is a skill which has its own set of technical difficulties.
Aim: To conduct an audit to study the common technical difficulties faced during epidural catheter placement and their management.
Material and Methods: The audit was conducted by evaluating the responses to a structured, self-administered questionnaire consisting of 10 questions distributed to post-graduate students, senior residents and consultants working in the Department of Anaesthesiology and Intensive care at a tertiary care centre in New Delhi during June 2017. The questions pertained to the respondent’s years of experience in Anaesthesiology and their response and management of the common technical difficulties encountered during epidural catheter placement.
Results: Out of a total of 111 respondents, 64.86% had less than 5 years and 13.51% had more than 10 years of experience in the field of anaesthesiology. Almost 92% used air for locating the epidural space by the Loss Of Resistance (LOR) technique. Varied responses were obtained regarding difficulties in catheter advancement and management of presence of CSF or blood in the catheter and regarding the use and benefits of placing an intrathecal catheter and the duration of keeping an intrathecal catheter in situ. Only 2.70% had experienced shearing of an epidural catheter and in all the cases, this was during catheter removal in the postoperative period.
Conclusion: There are no standard guidelines available for management of technical difficulties encountered during epidural catheter placement and this audit identified certain lacunae in knowledge and management of these difficulties.