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Obstructed catheter connection pin discovered during intrathecal baclofen pump exchange.
Clin J Pain. 2009 Mar-Apr; 25(3):256-9.CJ

Abstract

We report a case of catheter obstruction due to complete narrowing of the lumen of a connecting pin, and catheter disconnection in a patient undergoing intrathecal Baclofen pump exchange. The patient underwent intrathecal baclofen pump implantation for treatment of lower extremity spasticity and hypertonia secondary to congenital tetraplegia. Intrathecal baclofen dose escalation occurred over the course of treatment (73 mo) from 80 to 708 mcg/d representing a 189% increase in dose. The pump had neared the manufacturer's recommended exchange interval; therefore, a pump exchange was scheduled to surgically replace the device. One week before surgery, the patient noted a distinct increase in his symptomatology and began enteral baclofen therapy. During the surgery, the pump catheter was noted to be disconnected from the pump. Upon further examination, the lumen of the connection pin positioned between the pump catheter and intrathecal catheter was completely obstructed. Postsurgically, the patient's intrathecal baclofen dose was substantially reduced from 708 to 527 mcg/d (25.6% reduction) to control hypotonicity and to reestablish an Ashworth score of 2. We discuss intrathecal baclofen therapy and a unique complication associated with a catheter connecting pin.

Authors+Show Affiliations

Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA. pchrist2@jhmi.eduNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

19333178

Citation

Williams, Bryan S., and Paul J. Christo. "Obstructed Catheter Connection Pin Discovered During Intrathecal Baclofen Pump Exchange." The Clinical Journal of Pain, vol. 25, no. 3, 2009, pp. 256-9.
Williams BS, Christo PJ. Obstructed catheter connection pin discovered during intrathecal baclofen pump exchange. Clin J Pain. 2009;25(3):256-9.
Williams, B. S., & Christo, P. J. (2009). Obstructed catheter connection pin discovered during intrathecal baclofen pump exchange. The Clinical Journal of Pain, 25(3), 256-9. https://doi.org/10.1097/AJP.0b013e31818ba990
Williams BS, Christo PJ. Obstructed Catheter Connection Pin Discovered During Intrathecal Baclofen Pump Exchange. Clin J Pain. 2009;25(3):256-9. PubMed PMID: 19333178.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Obstructed catheter connection pin discovered during intrathecal baclofen pump exchange. AU - Williams,Bryan S, AU - Christo,Paul J, PY - 2009/4/1/entrez PY - 2009/4/1/pubmed PY - 2009/6/26/medline SP - 256 EP - 9 JF - The Clinical journal of pain JO - Clin J Pain VL - 25 IS - 3 N2 - We report a case of catheter obstruction due to complete narrowing of the lumen of a connecting pin, and catheter disconnection in a patient undergoing intrathecal Baclofen pump exchange. The patient underwent intrathecal baclofen pump implantation for treatment of lower extremity spasticity and hypertonia secondary to congenital tetraplegia. Intrathecal baclofen dose escalation occurred over the course of treatment (73 mo) from 80 to 708 mcg/d representing a 189% increase in dose. The pump had neared the manufacturer's recommended exchange interval; therefore, a pump exchange was scheduled to surgically replace the device. One week before surgery, the patient noted a distinct increase in his symptomatology and began enteral baclofen therapy. During the surgery, the pump catheter was noted to be disconnected from the pump. Upon further examination, the lumen of the connection pin positioned between the pump catheter and intrathecal catheter was completely obstructed. Postsurgically, the patient's intrathecal baclofen dose was substantially reduced from 708 to 527 mcg/d (25.6% reduction) to control hypotonicity and to reestablish an Ashworth score of 2. We discuss intrathecal baclofen therapy and a unique complication associated with a catheter connecting pin. SN - 1536-5409 UR - https://www.unboundmedicine.com/medline/citation/19333178/Obstructed_catheter_connection_pin_discovered_during_intrathecal_baclofen_pump_exchange_ L2 - http://dx.doi.org/10.1097/AJP.0b013e31818ba990 DB - PRIME DP - Unbound Medicine ER -