Letters to the Editor: Letters & Announcements
To the Editor
Gurnaney et al.1 describe great success using Dermabond (2-octyl cyanoacrylate glue) to decrease pericatheter leakage associated with continuous local anesthetic infusion. We note that the patients were discharged from the hospital with the catheter in situ and did not encounter any problems relating to removal of the catheter.1 We report our difficulties in 3 patients.
We are a tertiary pediatric center and routinely use continuous perineural infusions for perioperative analgesia. We too have had problems with premature displacement or removal of the catheter in our population, especially in the upper limb. In response, we tried various combinations of suturing/subcutaneous tunneling/tissue glue in an attempt to prolong catheter survival. Combining tunneling with tissue glue seemed to be the most mechanically stable. We used n-butyl-2-cyanoacrylate monomer (Indermil Tissue Adhesive; Henkel Ltd., Dublin, Ireland) to secure the catheter to the skin.
We have encountered difficulty in the removal of the catheter in 3 children in whom Indermil was used in combination with tunneling. A reasonable (moderate) amount of force was required to remove the catheters resulting in considerable distress to the patients in 2 cases, while the third required general anesthesia for catheter removal. We did not encounter a similar problem when catheters were tunneled and sutured before our introduction of Indermil glue.
Suggestions have been made in the literature regarding the use of warm soapy water,2,3 acetone,2,3 or petroleum jelly3 to facilitate catheter removal after use of tissue adhesives. We are reluctant to use acetone on broken skin and would like to know if Gurnaney et al. used these or any other techniques to aid in removing the catheter.
Deepa Bansi Jumani, DA, FRCA
Peter Murphy, FRCA, MRCPCH
Jackson Rees Department of Anaesthesia
Alder Hey Children's Hospital NHS Foundation Trust
Liverpool, United Kingdom
1. Gurnaney H, Kraemer FW, Ganesh A. Dermabond decreases pericatheter local anesthetic leakage after continuous perineural infusions. Anesth Analg 2011;113:206
2. Indermil literature information leaflet. Dublin, Ireland: Henkel Ltd
3. Klein SM, Nielsen KC, Buckenmaier CC III, Kamal AS, Rubin Y, Steele SM. 2-Octyl cyanoacrylate glue for the fixation of continuous peripheral nerve catheters. Anesthesiology 2003;98:590–1