Epidural Catheter Disconnects
A 74 year-old female with borderline renal function and a history of spinal stenosis has an epidural catheter in place. She is post-op day 2 from a colon surgery for cancer.
This morning, she was diagnosed with a PE, and was given 1mg/kg of enoxaparin. Six hours after the lovenox, the nurse calls the acute pain service. Apparently the epidural catheter has become disconnected in the last 3 hours (the disconnect was unwitnessed). The tips were found lying on the bed near the patient’s urinal.
How would you manage this situation?
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It is clear that the epidural catheter cannot be used. Also there is a great risk of epidural haematoma with removal. Considering the risks and benefit it seems appropriate to remove a length of the distal end of the catheter(10-15 cm) under aseptic precautions, usig sterile blade and dress up the the catheter in sterile manner. When appropriate interval has passed the catheter can be removed and next dose of enoxaparin given after six hours.
How did you come up with the length of catheter to remove?