Time-Dependent Efficacy of Bacterial Filters and Infection Risk in Long-Term Epidural Catheterization

Abstract

It is important for the reader of this abstract to understand that the clinical results of this study were obtained from cancer patients who had chronically implanted epidural catheters that were subcutaneously tunneled and were repeatedly injected several times daily for a period of weeks to months. The results of the study are very encouraging. With proper care and injection technique, it was possible to frequently inject such catheters left in place for weeks to months without serious risk of epidural infection. The authors' data are particularly reassuring in that all the epidural solutions used in the patients contained 4 mg of dexamediasone per 20 mL of solution. Two other results, obviously of great importance in catheter care, are: 1) regular changes of the bacterial filters not only were unnecessary but undesirable because such changes were associated with an increased risk of bacterial contamination; 2) filters made with nylon (Portex and Sterifix-Braun) were very effective for a prolonged period in preventing entry of bacteria into the cadieter and should be used in preference to filters made with cellulose (Encapsulon).

Last, the apparent safety and efficacy with which such chronically implanted catheters were used for prolonged periods of time make this anesthesiologist question the necessity of implantation of the many mechanical epidural infusion pumps used in numerous cancer and other chronic pain patients. Such