Department of Anesthesiology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu-shi, Shizuoka, 430-8558, Japan.
Department of General Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
BMC Anesthesiol. 2022 Jun 16;22(1):185. doi: 10.1186/s12871-022-01728-z.
Epidural catheters are associated with certain risks such as accidental epidural catheter removal, including dislodgement and disconnection. Globally, neuraxial connector designs were revised in 2016 to provide new standardization aimed at decreasing the frequency of misconnections during the administration of medications. However, no studies have investigated accidental epidural catheter removal after the revised standardization. This study aimed to examine differences in dislodgement and disconnection rates associated with different catheter connector types, and to investigate the linear tensile strength required to induce disconnection.
This retrospective cohort study included adult patients who underwent elective surgery and received patient-controlled epidural analgesia. Patients were divided into groups according to the type of catheter connection used: old standard, new standard, and new standard with taping groups. Furthermore, we prepared 60 sets of epidural catheters and connectors comprising 20 sets for each of the old, new, and taping groups, and used a digital tension meter to measure the maximum tensile strength required to induce disconnection.
This clinical study involved 360, 182, and 378 patients in the old, new, and taping groups, respectively. Dislodgement rates did not differ statistically among the three groups, while there was a significant difference in disconnection rates. Propensity score matching analysis for disconnection rates showed no difference between the old and new groups (2.8% vs. 4.5%, p = 0.574), while the new group had higher rates than the taping group (6.5% vs. 0%, p = 0.002). This laboratory study identified that a tensile strength of 12.41 N, 12.06 N, and 19.65 N was required for disconnection in the old, new, and taping groups, respectively, and revealed no significant difference between the new and old groups (p = 0.823), but indicated a significant difference between the new and taping groups (p < 0.001).
This clinical study suggested that dislodgement rates did not change among the three groups. Both clinical and laboratory studies revealed that disconnection rates did not change between the old and new connectors. Moreover, as a strategy to prevent accidents, taping the connecting points of the catheter connectors led to an increase in the tensile strength required for disconnection.
硬膜外导管与某些风险相关，如意外硬膜外导管移除，包括移位和断开。全球范围内，神经轴连接器设计于 2016 年进行了修订，以提供新的标准化，旨在减少药物给药过程中的误连接频率。然而，没有研究调查修订标准化后意外硬膜外导管移除的情况。本研究旨在检查不同导管连接器类型相关的移位和断开率的差异，并研究引起断开所需的线性拉伸强度。
这是一项回顾性队列研究，纳入了接受择期手术和患者自控硬膜外镇痛的成年患者。患者根据使用的导管连接类型分为旧标准组、新标准组和新带组。此外，我们准备了 60 套硬膜外导管和连接器，每组 20 套，分别用于旧标准、新标准和带组，并使用数字张力计测量引起断开所需的最大拉伸强度。
本临床研究中，旧标准组、新标准组和带组分别有 360、182 和 378 例患者。三组之间的移位率无统计学差异，而断开率有显著差异。对断开率进行倾向评分匹配分析显示，旧标准组和新标准组之间无差异（2.8%对 4.5%，p=0.574），而新标准组的断开率高于带组（6.5%对 0%，p=0.002）。本实验室研究发现，旧标准、新标准和带组的断开所需的拉伸强度分别为 12.41N、12.06N 和 19.65N，新旧标准组之间无显著差异（p=0.823），但新标准组和带组之间有显著差异（p<0.001）。
本临床研究表明，三组之间的移位率没有变化。临床和实验室研究均表明，旧标准和新标准连接器之间的断开率没有变化。此外，作为预防事故的一种策略，对导管连接器的连接点进行包扎导致断开所需的拉伸强度增加。
