Journal Article

P226 Nerve catheter disconnections: do they need to be resited?

Mayfield Adah, Phylactides Leonidas, Amin Kanish, Krol Andrzej

2025

Overview

Background and AimsNerve catheter infusions for perioperative and post trauma analgesia are increasingly common. Catheter disconnection predominantly leads to removal of the catheter, which could lead to increased pain, and the need to resite. We reviewed our local anaesthetic nerve catheter infusion database to identify patients with catheter disconnections and catheter outcomes.MethodsRetrospective review was performed of the pain service infusion catheter database from April 2023 to August 2024, identifying patients with witnessed or unwitnessed catheter disconnection. Electronic notes were reviewed to identify the location of disconnection, outcome of catheter, subsequent bacteraemia or catheter colonisation.Results69 (7.1%) Catheters were blocked, dislodged, pulled out or disconnected. 21 unwitnessed disconnections, 1 witnessed disconnection. 22 catheter disconnections (2.25%) from a total 974 inserted followed up between April 2023-August 2024. 5 in critical care, 1 in recovery, 16 on wards. All catheters except a witnessed disconnection were removed. 2 were resited on same day, 2 resited following day, and 19 catheters not resited. 15/22 tips not sent, 3 no growth, 4 tip positive, no bacteraemia identified, (6/22) had blood cultures sent.Abstract P226 Figure 1Catbeter outcome after disconnection[Image Omitted. See PDF.]Abstract P226 Figure 2Nerve catheter disconnection rates[Image Omitted. See PDF.]Abstract P226 Figure 3Catheter disconnection cause[Image Omitted. See PDF.]ConclusionsThe disconnection rates are reassuringly low at our institution. The current default is removing any nerve catheter that is disconnected. This could lead to increased pain, and usage of emergency anaesthetic time and operative space. There is little evidence to guide practice, except for central neuraxial catheter practice. Majority of catheter disconnections are between catheter and filter. Theoretically bulk flow of pathogens down a catheter that is disconnected would be low. We propose to wrap catheter in sterile gauze, stop infusion and refer for pain team/on call anaesthetist review for consideration of disinfecting end of catheter, cutting back with sterile scissors and reattaching with new filter. One should still employ strategies to minimise disconnection in the first place.

• Publisher: BMJ Publishing Group LTD
• Subject: Catheters