Quebra de cateteres peridurais: etiologia, prevenção e conduta

Adriano Bechara de Souza Hobaika

doi:10.1590/S0034-70942008000300005

Scientific Article

Quebra de cateteres peridurais: etiologia, prevenção e conduta

Breakage of epidural catheters: etiology, prevention, and management

Adriano Bechara de Souza Hobaika

http://dx.doi.org/10.1590/S0034-70942008000300005 Braz J Anesthesiol, vol.58, n3, p.227-233, 2008

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Resumo

JUSTIFICATIVA E OBJETIVOS: O objetivo desse estudo foi revisar os casos publicados de quebra de cateter peridural. Com as evidências coletadas na literatura, identificar os fatores que predispuseram a quebra e relacionar as condutas recomendadas para a prevenção e tratamento dessa complicação. MÉTODO: Foi realizada uma pesquisa do banco de dados da Pubmed, Embase e SciELO. RESULTADOS: Um total de 15 artigos foi identificado, relatando 30 casos de quebra de cateter peridural. Os casos foram avaliados quanto as informações referentes à cateterização e a retirada, além do tipo de cateter. Foram registradas as complicações provocadas pela presença dos fragmentos que ficaram retidos nos pacientes, além das indicações para a realização de laminectomia exploradora. Com as evidências obtidas na literatura, foram elaboradas recomendações referentes à profilaxia e ao tratamento dessa complicação. CONCLUSÕES: A introdução do cateter não deve ser feita mais do que 5 cm no espaço peridural. Deve-se proceder à laminectomia exploratória se o paciente apresentar sinais ou sintomas de alterações neurológicas, se o cateter estiver localizado dentro do espaço subaracnóideo ou quando a ponta quebrada do cateter estiver emergindo pela pele. Em decorrência da dificuldade em se localizar os fragmentos retidos com os exames de imagem disponíveis, os cateteres deveriam ser fabricados com materiais que facilitassem sua visualização.

Palavras-chave

COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: The objective of this study was to review published cases of breakage of epidural catheters and, with the data gathered in the literature, to identify predisposing factors for catheter breakage, and list the recommended conducts to prevent and treat this complication. METHODS: The search included the data banks of Pubmed, Embase, and SciELO. RESULTS: A total of fifteen studies reporting 30 cases of breakage of epidural catheters were identified. Information regarding the catheterization and removal of the catheter, besides the type of catheter, were analyzed for each case. Complications related to the presence of retained catheter fragments, as well as the indications for exploratory laminectomy, were recorded. With the evidence gathered from the literature, recommendations for prophylaxis and treatment of this complication were elaborated. CONCLUSIONS: The catheter should not be inserted more than five centimeters into de epidural space. Exploratory laminectomy should be undertaken if the patient develops signs or symptoms of neurologic changes, if the catheter is inside the subarachnoid space, or whenever the tip of the catheter is emerging out of the skin. Due to the difficulty to localize retained fragments by imaging exams, catheters should be manufactured with materials that improve their visualization.

Keywords

ANESTHETIC TECHNIQUES, Regional, COMPLICATIONS

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Quebra de cateteres peridurais: etiologia, prevenção e conduta

Breakage of epidural catheters: etiology, prevention, and management

Adriano Bechara de Souza Hobaika

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