Unsuspected intravascular migration of a thoracic epidural catheter in a thoracotomy patient: A case report

Nam, Karam; Seo, Jeong Hwa; Bahk, Jae Hyon

Case Report

Cardiothoracic and Vascular Anesthesia

Anesthesia and Pain Medicine 2013;8(3):184-186.
Published online July 30, 2013.

Unsuspected intravascular migration of a thoracic epidural catheter in a thoracotomy patient: A case report

Karam Nam, Jeong Hwa Seo, Jae Hyon Bahk

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea. bahkjh@snu.ac.kr

Abstract

Thoracic epidural analgesia is the most effective method of managing post-thoracotomy pain. However, the catheter may be misplaced into the intrapleural, intercostal, subarachnoid, or intravascular space. Intravascular misplacement of a catheter can be detected by aspiration of blood or administration of a test dose of local anesthetic; however, these methods may result in a false-negative response. Moreover, a catheter placed in the epidural space may migrate into a blood vessel during the intraoperative period. Thus, the location of the catheter tip should always be determined before local anesthetic is administered. We report a case of intraoperative intravascular migration of a thoracic epidural catheter in a 32-year-old male who underwent left thoracotomy.

Key Words: Blood vessels, Catheters, Epidural analgesia, Intraoperative complications, Punctures