A Simple System to Prevent Epidural Catheter Hub Disconnections

Abstract

To the Editor: Epidural catheter hub disconnections in the postoperative setting are a frustrating problem for the busy anesthesiologist, who must quickly proceed to the patient's bedside to examine and reconnect. Such disconnections may result in the introduction of contamination, possibly leading to an epidural abscess [1]. Disconnections may also result in loss of analgesia with subsequent patient dissatisfaction and in the waste of anesthesiologists' time, possibly at the cost of delaying care to other patients. Possible causes of disconnections include loose or improper connection, patient movement, excessive tension, and erroneous disconnection by health-care personnel. For the past 2 yr, we have been utilizing a simple and inexpensive improvement that appears to have totally eliminated all epidural catheter hub disconnections and their resultant problems (Figure 1). The epidural catheter is inserted, then securely taped up along the patient's back to the shoulder. The external tip of the epidural catheter is firmly secured to the hub, which is tightly connected to a 30-cm arterial line extension tubing at its male Luer-Lok end. The female Luer-Lok end of this extension tubing is securely connected to either the distal end of a continuous epidural infusion line or capped if no continuous infusion is utilized.Figure 1: Depiction of the simple system to prevent epidural catheter hub disconnections.At the patient's shoulder, the loose epidural catheter, hub, and beginning of the arterial line extension are coiled, placed onto a sterile gauze, and covered with a tightly applied, 15 x 20 cm, waterproof, transparent, self-adherent dressing. This dressing permits visualization of the connection, minimizes the number of health-care personnel manipulating the hub connection site, decreases the probability of introduction of contaminants and extraneous fluids into the hub, and provides a safeguard against unplanned disconnections during patient movement. The sterile gauze between the skin and the protruding hub provides a cushion of comfort for the patient. The cost of the arterial line extension plus the dressing approximates $3.00. This arrangement represents a significant improvement due to protection of the hub against contamination, tension, and manipulation by health-care personnel and the patient. Securing this weak link permits the patient to move in bed and ambulate with minimum risk of disconnection. Finally, the arterial catheter Luer-Lok facilitates both intermittent epidural boluses and continuous infusion line changes without pulling on the hub. David Breznick, MD Sheryl Artmann, MD Gordon A. Irving, MD Department of Anesthesiology; University of Texas-Houston Medical School; Houston, Texas 77030