EVALUATION OF A NEW PEDIATRIC EPIDURAL CATHETER:

S392 Insertion of an epidural catheter may be achieved via the caudal route in pediatric patients. This route should reduce the risk of dural puncture, however this technique is often associated with coiling of the catheter in the epidural space [1]. A new catheter is available (FlexTip Plus Catheter, Arrow International) which has an integral helical metal coil to provide stiffness for easy threading from the caudal space. Data was collected on the ease of use and success of placement when inserted in twenty pediatric patients. METHODS: The patients were divided into two groups (group 1: less than 24 months and group 2: greater than 24 months). IRB approval was obtained for publication of the data. Patients underwent general anesthesia prior to their caudal placement. After sterile preparation and skin nick, an attempt was made to pass the Crawford needle supplied in the Arrow kit through the sacrococcygeal ligament. If this failed an 18g, 1.25 inch long intravenous cannula was passed. The epidural space was then dilated with saline (1 ml for under one year, 2 mls for 1-4 years and 3-5 mls for over 4 years). The length of catheter to be inserted was measured from the skin overlying the sacrococcygeal ligament to the highest dermatome to be blocked. The ease of passage of the catheter was recorded as easy, difficult or impossible. The position of thoracic catheters were checked by x-ray and an aspiration test performed before a test dose was given. RESULTS: Data is given in the following Table 1:Table 1The Crawford needle was inserted easily in only 5 patients in group 1 and 2 in group 2. The venous cannula was used successfully for each failure. There was no incidence of dural puncture or bloody tap. The catheter was passed in all patients, however two were graded as difficult. Nine out of 12 thoracic catheters were correctly placed (7/9 and 2/5 respectively) as viewed on x-ray. The other 3 coiled. CONCLUSION: The FlexTip Plus Catheter inserted via the caudal route may be a safe and reliable alternative to the lumbar or thoracic epidural route particularly in younger patients. We recommend x-ray to confirm thoracic placement. Further investigation may be warranted to compare the FlexTip with other epidural catheters.