Safety of an improved pediatric epidural tunneling technique for catheter shear.

Abstract

Epidural tunneling could help with prolonged catheterization and be effective in preventing infection and dislodgement. However, epidural tunneling techniques carry a risk of catheter shear or needlestick injuries. This study aimed to examine the safety of our epidural tunneling technique in terms of catheter shear. This study was designed as a double-blinded, single-crossover, in vitro study. Each of the operators performed two techniques to create a subcutaneous tunnel. We compared outcomes between the control tunneling technique (group C) and our improved technique (group I). Microscopic findings of catheter shear were assessed as the primary outcome. Secondary outcomes included the tension and displacement required to break the epidural catheter and the frequency of catheter breakage due to catheter shear. Data were analyzed using the Fisher's exact test and Mann-Whitney U test. A p-value of <.05 was considered statistically significant. Ten catheters were assessed in each group. The frequency of catheter shear was 10% in group I and 90% in group C (odds ratio, 0.019; 95% confidence interval [CI], 0.01-0.31; p<.001). The frequency of catheter breakage due to catheter shear was significantly lower in group I (0%) than in group C (80%; p<.001). The mean tension and displacement required to break the catheter were significantly higher in group I than in group C (4.13±0.37N vs. 3.14±1.00N; mean difference, 0.99N; 95% CI, 0.25-1.73N; p=.013 and 222±59.9mm vs. 122±77.7mm; mean difference, 100mm; 95% CI, 34.1-165mm; p=.005). Our improved epidural tunneling technique, which was designed for pediatric cases, could reduce the risk of catheter shear.