Crack in the epidural catheter filter port

Sir,

Disconnection of epidural catheter and filter is not unknown.[1] However, damage to the injection port of the epidural catheter filter is uncommon. We encountered such a problem during the use of an epidural catheter set for postoperative pain relief.

A 68-year-old man posted for right total knee replacement for which lumbar epidural catheter (B. Braun Melsungen AG, Melsungen, Germany) was placed at L3–L4 space through the midline approach. The catheter assembly was used uneventfully for the initial 48 h while the patient received intermittent top-up doses of bupivacaine and morphine mixture. After 72 h, we witnessed slight leakage of the analgesic solution from injection port of the epidural catheter filter during injection of the top-up dose [Figure 1a]. On closer evaluation, we noticed that there was a crack in the catheter filter port leading to the spillage.

Figure 1.

(a) Epidural Filter Hub Crack. (b) Different nozzle diameters of 10-ml syringes of different makes

While investigating the possible cause of this occurrence, we came to know that different brands of disposable 10-ml syringes are supplied to our hospital. On closer observation, we also noticed that there exists slight difference in nozzle diameter of these syringes [Figure 1b]. We suspect use of a syringe with a slightly larger diameter might have led to the damage to injection port of epidural filter. We inadvertently try to snugly fit the syringe nozzle into the injection port of the catheter filter applying excessive force. We speculate that such an attempt might have contributed to the damage and the consequent leakage of medication. If gone unnoticed, such a spillage might cause inadequate pain relief and patient dissatisfaction, apart from creating other problems.

Although this event shows a lack of regulatory standardization, we suggest keeping in mind this unusual complication while administering the epidural top-up doses. Gentle application of syringe in the filter port and looking for any leakage during drug administration should be practiced. Another possible solution is use of syringes and epidural set of the same manufacturer to avoid these types of problems.

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