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

[Drains lombaires sous-arachnoïdiens: série de cas de cathéters brisés et un « near miss »]

Hernando Olivar, MD^*, John S. Bramhall, MD PhD^*, Irene Rozet, MD^*,, Monica S. Vavilala, MD^*,,, Michael J. Souter, MB BCh FRCA^*,, Lorri A. Lee, MD^*, and Arthur M. Lam, MD FRCPC^*,

^* From the Department of Anesthesiology,
Pediatrics, and
Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA.

Address correspondence to: Dr. Hernando Olivar, Acting Assistant Professor, Department of Anesthesiology Harborview Medical Center, University of Washington 325 9^th Avenue Seattle, WA, 98104, USA. E-mail: olivarh{at}u.washington.edu

Purpose: 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.

Clinical features: 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.

Discussion: 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.