Accidental Epidural Catheter Removal Rates and Strength Required for Disconnection: a Retrospective Cohort and Experimental Study

Background: Epidural analgesia requires the use of epidural catheters, which are associated with certain risks such as accidental epidural catheter removal, including dislodgement and disconnection. Few studies have investigated accidental catheter removal rates and directly compared them among epidural connector types. This study aimed to examine the differences in accidental catheter removal rates associated with different catheter connector types and to experimentally determine the linear tensile strength required to induce disconnection in each connector type.Methods: This retrospective cohort study included adult patients who underwent elective surgery and received patient-controlled epidural analgesia between December 2019 and August 2020. Patients were divided into groups according to the type of catheter connection used: standard (old group), new standard (new group), and new standard with taping (taping group). Furthermore, we prepared 60 sets of epidural catheters and connectors comprising 20 sets for each of the old, new, and taping groups, and used the digital tension meter to measure the maximum tensile strength required to induce disconnection. A multinomial logistic regression analysis was used to examine risk factors for disconnection. The experimental study groups were compared using one-way analysis of variance.Results: The clinical study involved in 920 patients (360, 182, and 378 patients in the old, new, and taping group, respectively). Dislodgement rates were similar among the three groups. Disconnection was most likely to occur in the new group (5.5%) and least likely to occur in the taping group (0.3%) compared to the old group (1.9%). However, the new group was not a risk factor for disconnection. The experimental study identified tensile strengths of 12.41 N, 12.06 N, and 19.65 N in the old, new, and taping groups, respectively. Comparison tests showed a significant difference in the tensile strength required for disconnection between the new and taping groups but not between the new and old groups.Conclusions: These findings suggest that taping the catheter connector connection may reduce the risk of disconnection, and thereby help improve patient outcomes. Further studies are required to clarify other parameters that may affect patient safety in this context.