Prevention of intrathecal drug delivery catheter-related complications

In an effort to improve the performance of implantable intrathecal drug delivery systems, a group of physicians experienced in the management of such devices reviewed surgical practices and principles that were associated with low catheter-related complication rates. Clinical study and postmarket data identified physicians whose patients experienced a relatively low rate of catheter-related complications. Six of those physicians (three anesthesiologists and three neurosurgeons) reviewed the number and types of intrathecal drug pumps and catheters they had implanted, with an emphasis on the specific details of successful catheter implantation techniques. The authors pooled their experiences to reach a consensus on implant techniques that are associated with a low rate of post-operative complications. The authors found that complications were minimized by the use of specific methods for catheter placement that included: a mid-to-upper lumbar dural entry level, a shallow-angle paramedian oblique insertion trajectory, and meticulous catheter anchoring and tunneling techniques. Systemic antibiotic prophylaxis, attention to pump pocket location, and surgical wound closure techniques also were important in reducing the incidence of postoperative devicerelated complications. Their experience indicates that specific implantation techniques using a variety of catheters and accessories can be expected to reduce the incidence of complications after implantation of intrathecal drug administration systems.