Inadvertent Intravascular Catheter Placement Using Predistention Verus Non-Predistention of Epidural Space Before Catheter Insertion: A Randomized Controlled Trial

Elena  B. Realubit,; Dawn  D. Zoleta,

Inadvertent Intravascular Catheter Placement Using Predistention Verus Non-Predistention of Epidural Space Before Catheter Insertion: A Randomized Controlled Trial

Abstract:

Epidural anesthesia is a common technique that may be used as surgical anesthetic or for postoperative pain management. It is safe and relatively easy to perform. One of its complication is accidental intravascular catheter placement. This study aimed to validate if epidural space predistention will prevent intravascular catheter insertion. This is a randomized controlled trial conducted from June to December 2022 which included patients admitted at MCUFDTMF Hospital for elective and emergency surgeries. A total of 76 patients were included with a computed sample size of 38 per group. Group I was the control group in which the epidural catheter was inserted without any predistention. Group II was the study group where in 5mL of normal saline solution was injected to the epidural space prior placement of epidural catheter. After placement and securing the epidural catheter, 3 ml solution consisting of 2% lidocaine and 1:200,000 epinephrine was given as a test dose. A positive test dose to intravascular placement is indicated by acute onset tachycardia (20 to 30 beats above baseline) within one minute of administration and an increase in systolic blood pressure (15 mmHg to 20 mmHg) without tachycardia. Catheters were observed for incidence of epidural vascular plexus injuries which would show bloody fluid in the epidural needle during puncture, or in the epidural catheter during catheter placement, aspiration of frank blood from the epidural catheter, or blood noted in the caudal end of the epidural catheter upon removal. Based on this study, distention of the epidural space with 5 mL saline prior epidural catheter placement is not significantly effective to decrease the incidence of inadvertent intravascular catheter insertion among patients who underwent surgical procedures.

References:

Z. Ahmed, M.A. Aziz, R. Waheed et al. Frequency of Intravascular Placement of Epidural Catheter with and Without Predistension of Epidural Space with Saline. PJMHS Vol. 13, No. 2, Apr – Jun 2019
C.B. Han, L. Yu, Y. N. Qian et al. Effects of Predistention with Normal Saline Containing Adrenaline on Blood- vessel Injury during Epidural Catheter Placement. The Journal of International Medical Research 2011; 39: 2302 – 2306
D. N. Bell, K. Leslie. Detection of intravascular epidural catheter placement: A review. Anaesthesia and Intensive Care, 35, No. 3, June 2007
C.K. Shih et al. Soft catheters reduce the risk of intravascular cannulation during epidural block. A retrospective analysis of 1117 cases in a medical center. Elsevier. Kaohsiung Journal of Medical Sciences (2012) 28, 373e376. doi:10.1016/j.kjms.2012.02.004
C. Han, Q. Zhou et al. Effects of epinephrine in the epidural space on the incidence of blood vessel injury by epidural catheter insertion for cesarean section: a prospective, randomized, double-blind study. Elsevier Journal of Clinical Anesthesia (2015) 27, 7–11 http://dx.doi.org/10.1016/j.jclinane.2014.09.004
G. Geng, X. Sun, S. Huang et al. Effect of preloading epidural space with normal saline on the incidence of complications of epidural catheter placement and spinal anesthesia for cesarean section. Springer Science+Business Media New York June 10, 2013 DOI 10.1007/s10877-013-9527-5
J.M. Mhyre, M.L. Greenfield et al. A Systematic Review of Randomized Controlled Trials That Evaluate Strategies to Avoid Epidural Vein Cannulation During Obstetric Epidural Catheter Placement. Anesth Analg 2009;108:1232–42 International Anesthesia Research Society DOI: 10.1213/ane.0b013e318198f85e
S. Evron et al. Predistention of the Epidural Space Before Catheter Insertion Reduces the Incidence of Intravascular Epidural Catheter Insertion. Anesth Analg 2007;105:460–4. 2007
D. Harney, C. Moran, R. Whitty et al. Influence of posture on the incidence of vein cannulation during epidural catheter placement. European journal of anaesthesiology 2005;22(2):103-6