Tunneled Epidural Catheter

Frequently asked questions about tunneled epidural catheter

What is a tunneled epidural catheter?

            A tunneled epidural catheter is a very small, thin, bendable tube that is put under the skin and implanted into the epidural space in the spine. Medicine can now be injected into this tube that has the ability to stop the nerve from sensing any type of pain.

Who might take advantage of a tunneled epidural catheter?

            This procedure is used many times if a patient is recovering from cancer. It is also used for someone who is in pain for an extended period of time after major chest surgery. Any patient that is subjected to long periods of pain that can’t be controlled by oral medication may be able to take advantage of a tunneled epidural catheter. The procedure will only be administered after the patient has tried all other means of pain management and has been unsuccessful.

How is the tunneled epidural catheter procedure done?

            The patient is first given medication through an intravenous tube to calm them down. They also administer an antibiotic as a preventive measure at this time. The patient then is asked to lie on their stomach on an x-ray table. Then the physician will give the patient a local anesthetic to numb their back. At this point, an x-ray will help the doctor position the needle into the correct spot of the spine. Then the catheter is inserted into the epidural space by way of the needle. The catheter is tunneled under the skin and then is left sticking out of the back. This will be taped in place so medication can be administered through the catheter as needed.

Are there any risks associated with the tunneled epidural catheter procedure?

            The epidural space in the spine may be at risk for getting infected. There also is a risk of infection at the spot where the tube enters the body. These must be monitored very frequently so the chance of this happening is low. Antibiotics are also administered at the beginning of the procedure to reduce the risk of infection. There are some other risks involved with this procedure also. There may be dizziness, numbness or weakness of the legs, or discomfort around the insertion point of the catheter. Most of these side effects are manageable and will go away after a short period of time. There is also a possibility the catheter will move and become ineffective so there have been many different techniques used to prevent this from happening. They have tried to secure the catheter by coiling it outside the skin and have had some success.

What can be expected after the tunneled epidural catheter procedure is completed?

            The patient will be observed for 15 minutes after the procedure. Then the patient will remain in the hospital for two or three days so the physician can adjust the medicine to the patient’s particular circumstance. The doctor will recommend no extreme activity and a regular diet. Then the patient will be asked to return every couple of weeks so the dressing can be changed around the catheter and the catheter site can be checked.

References:

Jong PC & Kansen PG. A comparison of epidural catheters with and without subcutaneous injection ports for the treatment of cancer pain. Anesthesia and Analgesia 1994; 78: 94 100.

Moran KT, McEntee G, Jones B, Hone R, Duignan JP, O’malley E. To tunnel or not to tunnel catheters for parenteral nutrition. Annals of the Royal College of Surgeons of England 1987; 69: 235 6.

Andrivet P, Bacquer A, Canh Vu Ngoc Ferme C, Letinier JY. Lack of clinical benefit from subcutaneous tunnel insertion of central venous catheters in immunocompromised patients. Clinical Infectious Diseases 1994; 18: 199 206.

Du Pen S, Peterson DG, Williams A, Bogosian A. Infection during chronic epidural catheterization: diagnosis and treatment. Anesthesiology 1990; 73: 905 9.