Subarachnoid lumbar drains: a case series of fractured catheters and a near miss

• Published in: Canadian journal of anesthesia Vol. 54; no. 10; pp. 829 - 834
• Main Authors: Olivar, Hernando, Bramhall, John S, Rozet, Irene, Vavilala, Monica S, Souter, Michael J, Lee, Lorri A, Lam, Arthur M
• Format: Journal Article
• Language: English
• Published: United States Springer Nature B.V 01-10-2007
• Subjects: Adult; Aged; Catheterization - adverse effects; Catheters; Cerebrospinal Fluid; Device Removal; Drainage - instrumentation; Equipment Failure; Female; Humans; Intraoperative Complications; Lumbosacral Region; Male; Middle Aged; Neurosurgical Procedures - methods; Retrospective Studies; Risk Factors; Spinal Puncture - instrumentation; Subarachnoid Space
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/bf03021711

Lumbar subarachnoid catheters for cerebrospinal fluid (CSF) drainage (lumbar drains) are indicated for several medical and surgical conditions. A number of complications can occur from the placement of this type of catheter, including catheter breakage from excessive traction or shearing over the Tuohy needle.
Five cases of lumbar subarachnoid catheter breakage/shearing and catheter fragment retention, as well as one near miss, were identified over a one-year period at a single institution. All (n = 6) patients were undergoing neurosurgical procedures. Four patients required surgical retrieval of the catheter fragments. No patient experienced log-term neurological sequelae.
From these experiences, the following risks factors for catheter rupture are identified: 1) intentional or accidental retraction of the catheter through the needle during placement; 2) faulty use of the guidewire; or 3) use of excessive force during removal of the catheter. Methods to prevent such complications are suggested, including minimal use, or complete avoidance of a guidewire.