Differentiated Approach to the Method of Fixing the Epidural Catheter

Abstract

   AIM OF STUDY. To study the individual structural features of the surface of the lumbar region of the back of patients who underwent catheterization of the epidural space at the lumbar level, and, depending on these features, to determine a group of patients with the possibility of convenient and reliable fixation of the epidural catheter (EC) to the skin with fixing devices and a group of patients who require such fixation will be inconvenient and unreliable and for whom it is better to use subcutaneous tunneling for reliable fixation of the EC, and based on this, determine the absolute and relative indications for this method of fixation.   MATERIAL AND METHODS. A study of the surface of the lumbar region of the back was carried out in 600 patients who were on the operating table in a sitting position, while performing neuraxial blockades in the intervertebral spaces L2–L3 and L3–L4. As a result, 4 forms of the back surface were identified: “V” shape, “M” shape, “^” shape and “—” flat shape of the back surface.   RESULTS. The overwhelming majority of the studied patients had absolutely convenient (34.2 %) and relatively convenient (53.5 %) places for EC fixation in the area of epidural access. Significantly fewer patients (2 %) had a completely uncomfortable site for EC fixation to the skin using fixation devices, which can be considered an absolute indication for EC fixation by subcutaneous tunneling.   CONCLUSION. 1. The absolute indication for fixing an epidural catheter using the subcutaneous tunneling method is the presence of an absolutely uncomfortable fixation site in the area of epidural access in the patient in the form of a combination of a recess greater than 7 mm and a distance from the points of maximum elevation in the specified zone to the right and left of the midline less than the size of the dense adhesive plate of the fixing device (for the Epi-Fix device this is 55 mm). 2. A relative indication for fixing an epidural catheter using the subcutaneous tunneling method is the presence of a relatively inconvenient fixation site in the epidural access area for the patient, regardless of the size of the depression or elevation of the surface shape at the epidural access site and the distance from the points of maximum elevation to the right and left of the larger midline than the size of the dense adhesive plate of the fixing device.