Removing knotted or stuck epidural catheters: a systematic review of case reports

Abstract

Background: The knotting or in vivo entrapment of epidural catheters is an uncommon butchallenging issue for anesthesiologists. This study aimed to identify the possible causes behindentrapped epidural catheters and the effective methods for their removal.Methods: A systematic review of relevant case reports and series was conducted using thepatient/population, intervention, comparison and outcome framework and keywords suchas “epidural,” “catheter,” “knotting,” “stuck,” “entrapped,” and “entrapment.” The PreferredReporting Items for Systematic Reviews and Meta-Analyses statement was followed, andthe review protocol was registered with International Prospective Register for Systematic Reviews(CRD42021291266).Results: The analysis included 59 cases with a mean depth of catheter insertion from theskin of 11.825 cm and an average duration of 8.17 h for the detection of non-functioningcatheters. In 27 cases (45.8%), a radiological knot was found, with an average length of2.59 cm from the tip. The chi-squared test revealed a significant difference between the initialand final positions of catheter insertion (P = 0.049).Conclusions: Deep insertion was the primary cause of epidural catheter entrapment. To removethe entrapped catheters, the lateral decubitus position should be attempted first, followedby the position used during insertion. Based on these findings, recommendations forthe prevention and removal of entrapped catheters have been formulated.