title: When to remove an epidural catheter in a parturient with disseminated intravascular coagulation.
abstract: OBJECTIVE
  Pain from labor and delivery is often attenuated with epidural anesthesia. A complication of indwelling epidural catheters is intraspinal hematoma. The development of a bleeding diathesis can worsen complications markedly.
  
  
  CONCLUSIONS
  Frequent assessment of neurologic status is important until the underlying cause of the coagulopathy can be treated and the bleeding resolves. If there is no indication of intraspinal bleeding, we recommend removing the catheter because of potential catheter migration. If bleeding is occurring around the catheter insertion site and possibly in the epidural or subarachnoid space, the catheter may be left in place to tamponade the insertion site. In cases of intraspinal hematoma, which can cause neurologic deficits, immediate decompression surgery is needed.
authors.affiliation: Department of Anesthesiology, Medical College of Wisconsin, Milwaukee 53226.
authors.forename: J
authors.initials: J
authors.lastname: Sprung
authors.forename: E Y
authors.initials: EY
authors.lastname: Cheng
authors.forename: S
authors.initials: S
authors.lastname: Patel
mesh_terms: D000208:Acute Disease; D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D002408:Catheters, Indwelling; D002585:Cesarean Section; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D007744:Obstetric Labor Complications / Q000209:etiology*; D011247:Pregnancy