Knotting of a Lumbar Epidural Catheter during its Removal

Knotting of an epidural catheter is a rare complication during the removal of an epidural catheter. There are many factors for knotting of an epidural catheter, such as the characteristics of the catheter itself, patient's factors [anatomy, position during insertion and removal of the catheter, and the body mass index (BMI)], the difficulty of the procedure and the distance of advancing the catheter in epidural space. During its removal, we experienced a knot of a lumbar epidural catheter which was inserted for labor pain analgesia. The knot was successfully removed. In this case, the knotting was due to long distance advancement of the catheter, which was double knotted and looped in epidural space, far from its distal tip. To prevent this complication, catheters should be left with less than 6 cm in length in the epidural space.