The Aspiration of Injected Air via an Epidural Catheter as an Indicator for Appropriate Placement of the Catheter in the Epidural Space

BACKGROUND: The "gold standard" for proper epidural catheter positioning is a clinical response, as assessed by a pinprick test. Yet it may take time or it may be difficult to perform this test after epidural catheter placement in sedated or uncooperative patients or during general anesthesia. We assessed the usefulness of aspirating injected air via an epidural catheter as an indicator of correct epidural catheter placement. METHODS: We surveyed 200 patients who underwent surgery under general or epidural anesthesia. A Tuohy needle was inserted into the epidural space with using the hanging drop technique. After placement of the epidural catheter, 3 ml of air was injected via the catheter, and then the volume of aspirated air was measured. RESULTS: The mean volume of aspirated air was 2.3 +/- 0.7 ml (75% of the injected air volume) and this ranged from 0 to 3 ml. CONCLUSIONS: Aspiration of injected air is a simple alternative method for identifying the appropriate placement of epidural catheters in the epidural space.

A Broken J-Guide Wire during Central Venous Catheterization : A case report

J-guide wires have been widely used for central venous catheterization with the popularity of the Seldinger technique. However, many adverse sequelae of central venous catheterization have been reported. We report two cases of J-guide wire breakage during central venous catheterization. Venipuncture by a steel needle was easily achieved in each case. However, insertion of a J-guide wire was difficult to perform, and pulling out the guide wire from the steel needle was more difficult, which caused breakage of the core and the uncoiling of the spring coil of the guide wire. The tip of the guide wire was not cut off, and there were no complications. With the removal of the guide wire, weak resistance was felt that which was not supposed to be sufficient to cut off the guide wire. It was assumed that an inherent fault in the manufacturing process of the guide wire could lead to this type of breakage.