title: [Rare medical incidents: Actual consensus statement for the removal of neuraxial catheter fragments].
abstract: The rupture of a catheter near the spine is rare. There are no evidence-based guidelines for diagnosis and therapy. Opinions derived from German anesthesiologists, neurosurgeons, orthopaedics and trauma surgeons are: Infants should have immediate surgery. In an asymptomatic adult, the catheter fragment does not require removal surgery. Antibiotic prophylaxis is not necessary. If symptomatic, the catheter fragment should be localized by a thin slice computed tomography or fluoroscopy. Otherwise surgical exploration is indicated. Direct surgery is recommended for cases with neurological symptoms, infections, loss of spinal fluid, pain and local discomfort. Relative indications for surgery are severe pain, tissue infection and intrathecal localization of the fragment. Surgery should be performed in prone position and under general anesthesia. Starting at the entry wound, the surgical access should be microsurgical and preferably by a neurosurgeon. If the entry is not detectable, a midline incision is suggested.
authors.affiliation: Robert-Bosch-Krankenhaus -Klinik Schillerhöhe in Gerlingen. thomas.frietsch@klinikschillerhoehe.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Frietsch
authors.forename: Anne-Friederike
authors.initials: AF
authors.lastname: Lieb
authors.forename: Hinnerk
authors.initials: H
authors.lastname: Wulf
authors.forename: Steffen
authors.initials: S
authors.lastname: Ruchholtz
authors.forename: Claudius
authors.initials: C
authors.lastname: Thome
mesh_terms: D000465:Algorithms; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000295:instrumentation*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D057785:Catheters; D032921:Consensus; D004868:Equipment Failure / Q000706:statistics & numerical data; D005471:Fluoroscopy; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008866:Microsurgery; D019635:Neurosurgical Procedures; D010146:Pain / Q000209:etiology; D013116:Spinal Cord / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents