Accidental epidural catheter removal rates and strength required for disconnection: a retrospective cohort and laboratory study

BMC Anesthesiology

Yoshie Toba¹  Yoshiaki Ishida¹  Masatoshi Sagawa²  Takashi Kawamura²  Yoichiro Homma³ 

[1] Department of Anesthesiology, Seirei Hamamatsu General Hospital;Department of Clinical Engineering, Seirei Hamamatsu General Hospital;Department of General Internal Medicine, Seirei Hamamatsu General Hospital;

关键词: Epidural analgesia;    Epidural catheter;    Accidental removal;    Catheter connector;    Dislodgement;    Disconnection;   

DOI  :  10.1186/s12871-022-01728-z

来源: DOAJ

【 摘 要 】

Abstract Background Epidural catheters are associated with certain risks such as accidental epidural catheter removal, including dislodgement and disconnection. Globally, neuraxial connector designs were revised in 2016 to provide new standardization aimed at decreasing the frequency of misconnections during the administration of medications. However, no studies have investigated accidental epidural catheter removal after the revised standardization. This study aimed to examine differences in dislodgement and disconnection rates associated with different catheter connector types, and to investigate the linear tensile strength required to induce disconnection. Methods This retrospective cohort study included adult patients who underwent elective surgery and received patient-controlled epidural analgesia. Patients were divided into groups according to the type of catheter connection used: old standard, new standard, and new standard with taping groups. Furthermore, we prepared 60 sets of epidural catheters and connectors comprising 20 sets for each of the old, new, and taping groups, and used a digital tension meter to measure the maximum tensile strength required to induce disconnection. Results This clinical study involved 360, 182, and 378 patients in the old, new, and taping groups, respectively. Dislodgement rates did not differ statistically among the three groups, while there was a significant difference in disconnection rates. Propensity score matching analysis for disconnection rates showed no difference between the old and new groups (2.8% vs. 4.5%, p = 0.574), while the new group had higher rates than the taping group (6.5% vs. 0%, p = 0.002). This laboratory study identified that a tensile strength of 12.41 N, 12.06 N, and 19.65 N was required for disconnection in the old, new, and taping groups, respectively, and revealed no significant difference between the new and old groups (p = 0.823), but indicated a significant difference between the new and taping groups (p < 0.001). Conclusions This clinical study suggested that dislodgement rates did not change among the three groups. Both clinical and laboratory studies revealed that disconnection rates did not change between the old and new connectors. Moreover, as a strategy to prevent accidents, taping the connecting points of the catheter connectors led to an increase in the tensile strength required for disconnection.

【 授权许可】

Unknown