Science, Medicine, and the Anesthesiologist: Key Papers from the Most Recent Literature Relevant to Anesthesiologists
	Images in Anesthesiology: An Impacted Epidural Catheter

Education | September 2019 An Impacted Epidural Catheter Patrick N. Odonkor, M.B., Ch.B.; Seema P. Deshpande, M.B., B.S.; Andy M. Malinow, M.D. Author Notes From the University of Maryland School of Medicine, Baltimore, Maryland. Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org). Address correspondence to Dr. Odonkor: podonkor@som.umaryland.edu Anesthesiology 9 2019, Vol.131, 664. doi:10.1097/ALN.0000000000002738 VIEW PDF SHARE EMAIL TWITTER FACEBOOK GOOGLE PLUS LINKEDIN TOOLS ALERTS Rarely, an epidural catheter becomes impacted, causing difficulty upon withdrawal from the patient. Such difficulty has been attributed to “kinking, curling, coiling, knotting and looping” of the epidural catheter in the epidural space1 or entrapment in muscle, ligaments, joints, or bony structures.2,3 If multiple attempts at withdrawal by gentle traction in multiple patient positions is unsuccessful or if the catheter becomes disrupted, leaving a distal fragment in the patient, the impacted epidural catheter should be evaluated by neuraxial imaging1 using computerized tomography (Supplemental Digital Content 1, http://links.lww.com/ALN/B932), magnetic resonance imaging (if there is no metal in the epidural catheter), plain radiography, and/or ultrasonography to determine the mechanism of impaction. A three-dimensional multidetector computerized tomography reconstruction with color enhancement (panel A; Supplemental Digital Content 1, http://links.lww.com/ALN/B932) provides additional spatial information not seen with traditional computerized tomography imaging (panel B), thereby facilitating localization and visualization of the entire length of the retained distal epidural catheter fragment to enhance diagnostic evaluation and guide clinical management.