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CASE REPORTS
Retained Intrathecal Catheter Fragment After Spinal Drain Insertion: Steps for Prevention and Management
  1. Akara Forsythe, MD*,
  2. Anita Gupta, DO, PharmD† and
  3. Steven P. Cohen, MD‡
  1. From the *Department of Anesthesiology, The Johns Hopkins School of Medicine, Baltimore, MD;
  2. †Pain Management Division, Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, PA; and
  3. ‡Pain Management Division, Department of Anesthesiology, The Johns Hopkins School of Medicine, and Department of Surgery, Walter Reed Army Medical Center, Washington, DC.
  1. Address correspondence to: Steven P. Cohen, MD, The Johns Hopkins Pain Management Division, 550 North Broadway, Suite 301 Baltimore, MD 21205 (e-mail: scohen40{at}jhmi.edu).

Abstract

Background and Objectives: The placement of lumbar spinal drains is being done with increasing frequency to facilitate high-risk surgical procedures. One risk associated with these procedures is catheter shearing, resulting in a retained foreign body in the intrathecal space. Unlike retained epidural fragments, there are no guidelines on the management of this complication. The purpose of this article was to synthesize the literature on this subject to come up with guidelines for preventing and managing this complication.

Methods: Case report and review of all published cases.

Results: Most cases of retained catheters are associated with difficulty inserting or advancing the catheter. Among those cases treated conservatively, approximately one third of patients developed symptoms. Factors that must be considered when weighing the decision to surgically remove the retained catheter include patient comorbidities and desires, size and location of the fragment, infectious risk, the presence of neurologic symptoms, and scheduled surgical procedure.

Conclusions: A retained intrathecal catheter can be managed conservatively in certain contexts. Periodic follow-up visits, with or without repeat imaging, are recommended in these circumstances.

https://doi.org/10.1097/AAP.0b013e3181ac9e8a

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    Footnotes

    • Disclaimers and conflicts of interest: None.

    • Dr. Cohen receives funding from a Congressional Grant from the John P. Murtha Neuroscience and Pain Institute, Johnstown, PA, and the Army Regional Anesthesia and Pain Management Initiative, Washington, DC.