A Pediatric Epidural Catheter Fracture Suspected to Be Caused by a Glue

TL;DR

A baby's epidural catheter fractured, likely due to ethyl-2-cyanoacrylate glue used for fixation, leading to surgical removal.

Contribution

Highlights a potential risk of using ethyl-2-cyanoacrylate glue for pediatric epidural catheter fixation.

Findings

Epidural catheter fractured 67mm from the tip, suspected to be caused by ethyl-2-cyanoacrylate glue.

Microscopic inspection showed 20% tearing and 80% cracking in the catheter cross-section.

Simulation using the same glue on a polyolefin resin plate resulted in catheter fracture after three days.

Abstract

A 65-day-old baby boy underwent the Kasai procedure under general and epidural anesthesia. The epidural catheter was inserted between the T11 and T12 vertebrae under general anesthesia, and secured with sterile tape, ethyl-2-cyanoacrylate glue, and film. Intra- and postoperative epidural analgesia was effective and there was no leakage around the insertion site. On the third day post-surgery, we tried to remove the catheter but discovered it was fractured 67mm from the tip. During the ultrasound examination, we observed a hyper-echoic structure located between the laminae of T11/T12. The pediatric orthopedic surgeon recommended removing the catheter to avoid long-term neurological sequelae of leaving the catheter, such as infection, fibrosis, migration, and irritation of neural tissues. It was surgically removed uneventfully on postoperative day 4. We requested the manufacturer to inspect the cross-section of the catheter under a microscope. The cross-section showed that 20% of the area had undergone tearing due to traction, while the remaining 80% was cracked. We also requested the manufacturer simulation after that. The same catheter, fixed on the polyolefin resin plate instead of skin with the same tape and glue, was easily fractured after three days. It is suspected that using ethyl-2-cyanoacrylate glue caused the catheter to fracture. When using glue containing ethyl-2-cyanoacrylate for pediatric epidural catheter fixation, special care is advised.

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