The Difficulty to Remove Perineural Catheter: A Technique for Removing an Intact Catheter

Abstract

Continuous perineural catheters are used for postoperative pain management following inpatient or outpatient orthopedic surgery. One of the potential complications is shearing and breaking of the catheters during removal. The metallic coiled tip Stimu Cath catheter may contribute to formation of adhesions. Depletion of the local anesthetic infusion prior to attempted removal of the catheter may contribute to formation of adhesions around the catheter. Once the infusion of local anesthetic is finished, there is no longer a pocket of fluid around the catheter and tissue may begin to collapse and form adhesions, making removal difficult. Our strategy in dealing with a catheter that is difficult to remove is to keep the catheter connected to the pump, avoiding contamination as well as preserving the integrity of the catheter by avoiding shearing and breakage. One of the concerns with a “stuck” catheter is that the catheter may have adhered to a neural structure and that pulling and tugging could cause nerve damage. Prior to manipulating the catheter, we perform an ultrasound examination to ascertain its exact location, we then bolus sterile saline through the catheter. We feel that infusing 30 to 50 ml of sterile saline, slowly and incrementally will expand the area around the catheter and aid in removal without significant risk of compression neuropathy.