Verifying accurate placement of an epidural catheter tip using electrical stimulation

Thoracic epidural catheters via the caudal and lumbar approaches using styletted multiple port catheters in pediatric patients: a report of three cases

Advancing catheters from the lumbar and caudal epidural spaces to the thoracic level has been reported to be an alternative to the direct thoracic approach. However, as children grow, the threading of catheters in the epidural space becomes increasingly difficult. This report describes three cases of thoracic epidural placement using a multiport catheter threaded from the caudal and lumbar spaces using electrical stimulation guidance. In the first case, a multiport catheter was threaded 22 cm from the lumbar space to T8 following a failed attempt with a single-port catheter in a 9-year-old boy scheduled to undergo a right nephrectomy. In the second case, a multiport catheter was threaded 26 cm from the caudal space to T9 in a 3-year-old girl undergoing fundoplication. In the last case, a multiport catheter was inserted at the completion of a fundoplication in a 2-year-old girl after it had been confirmed that the single-port catheter inserted prior to surgery had not advanced to the desired thoracic level. The multiport catheter was threaded 17 cm without resistance from the caudal space to T9. In all cases, electrical stimulation was used to confirm the location of the catheter tip at the time of insertion. The position of the catheters was later confirmed by X-ray. The multiport catheter incorporates a stylet, which extends to a closed distal tip, within a catheter body that ejects fluid from three lateral holes in a direction perpendicular to the advancing catheter. These properties may facilitate the reliable advancement of catheters in the epidural space.