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The Migration of Caudally Threaded Thoracic Epidural Catheters in Neonates and Infants

Simpao, Allan F. MD, MBI*; Gálvez, Jorge A. MD, MBI*; Wartman, Elicia C. BA; England, W. Randall BA; Wu, Lezhou PhD; Rehman, Mohamed A. MD; Ngo, Thienkim V. MD§

doi: 10.1213/ANE.0000000000003311
Pediatric Anesthesiology: Original Clinical Research Report
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BACKGROUND: The migration of pediatric thoracic epidural catheters via a thoracic insertion site has been described. We assessed the migration of caudally threaded thoracic epidural catheters in neonates and infants at our institution.

METHODS: The anesthesia records and diagnostic imaging studies of neonates and infants who had caudal epidural catheters placed during a 26-month period at our hospital were analyzed. Imaging studies were reviewed for changes in epidural catheter tip position.

RESULTS: Eighty-five patients 1–325 days of age (median, 51 days; interquartile range, 39–78 days) and weights of 2.5–9.5 kg (median, 5 kg; interquartile range, 4.3–5.8 kg) met the study criteria. Fifty-four (64%) of the patients (95% CI, 52%–73%) experienced catheter migration of 1 or more vertebral levels (range, 3 levels caudad [outward] to 3 levels cephalad [inward]), and 23 (27%) of the patients (95% CI, 18%–38%) experienced catheter migration to the T4 level or higher. Migration of 2 or more vertebral levels occurred only in children who weighed <6 kg and were under 73 days of age.

CONCLUSIONS: Epidural catheter migration occurs commonly in neonates and infants. Postoperative imaging is crucial to confirm catheter tip location after epidural catheter placement, as failure to assess catheter migration might result in suboptimal analgesia or other undesirable outcomes.

From the *Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

Department of Anesthesiology and Critical Care Medicine, General Anesthesia Division, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

Department of Anesthesiology, Johns Hopkins All Children’s Hospital, St Petersburg, Florida

§Department of Anesthesiology, Anesthesia Service Medical Group, Inc, Rady Children’s Hospital San Diego, San Diego, California.

Published ahead of print 22 December 2017.

Accepted for publication December 22, 2018.

Funding: Departmental.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Allan F. Simpao, MD, MBI, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104. Address e-mail to simpaoa@email.chop.edu.

Copyright © 2018 International Anesthesia Research Society
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