Separation of stimulating catheters for continuous peripheral regional anesthesia during their removal – two case reports and a critical appraisal of the use of steel-coil containing stimulating catheters

Abstract

Thomas Wiesmann,1 Pascal Wallot,1 Laura Nentwig,1 Alisha-Viktoria Beermann,1 Hinnerk Wulf,1 Martin Zoremba,1 Turfa Al-Dahna,1 Daphne Eschbach,2 Thorsten Steinfeldt11Department of Anesthesia and Intensive Care Medicine, University Hospital Marburg, Marburg, Germany; 2Department of Trauma, Hand and Reconstructive Surgery, University Hospital Marburg, Marburg, GermanyPurpose: Stimulating catheters are widely used for continuous peripheral nerve block techniques in regional anesthesia. The incidence of reported complications is somewhat similar to that for non-stimulating catheters. However, as many stimulating catheters contain a coiled steel wire for optimal stimulation, they may cause specific complications.Clinical features: In this report, we present two cases of complicated removals of stimulating catheters. During both removals, a part of the metal wire was left “decoiled” next to the supraclavicular and interscalene plexus, respectively. The strategies used to determine steel wire localization and a description of the successful removal of these steel wires are included in this report.Conclusion: Catheter separation and problems with residual metal wire components of stimulating catheters seem to be a rare but specific problem during removal. Anesthesiologists should strictly avoid catheter shearing during insertion, adhere to the manufacturer’s instructions, and take care during catheter removal. Manufacturers should focus on technical solutions to avoid rare but relevant complications such as catheter tip decoiling and separation of stimulating catheters during removal.Keywords: stimulating catheter, catheter separation, complication, peripheral nerve block, perineural catheter