Evaluating Verification Modalities for Epidural Catheter Placement

Epidurogram is the current gold standard for confirmation of epidural catheter placement. 

Compuflo CathCheck is a non-invasive system utilizing pulse wave analysis to determine catheter location with minimal risk to the patient

 Determine if Compuflo CathCheck system can accurately confirm the correct placement of a thoracic epidural catheter, verified with epidurogram

 Other methods of correct epidural catheter placement were also evaluated, including meniscus test and physical exam

Single center crossover study at the University of Minnesota 

After IRB approval, informed consent was obtained on all patients prior to their epidural placement, per standard protocol 

Each patient underwent 4 different catheter detection modalities: meniscus test, sensory examination with ice, Compuflo CathCheck (Milestone Scientific,Livingston, NJ), and epidurogram 

All exams were performed or interpreted by an individual who was blinded to the other tests

The results of all testing was sent to a research assistant that compiled and entered all data.

All testing was validated with the epidurogram

Correct epidural catheter placement was confirmed via epidurogram in 16 subjects

Incorrect placement, outside of the epidural space, was confirmed in 3 subjects

CompuFlo CathCheck system had 100% agreement with the results of epidurogram for both correct and incorrect placement

Physical Exam was in agreement with epidurogram 56% of the time for correctly placed epidurals, 33% of the time for incorrect placement

Meniscus Test was in agreement with epidurogram 63% in correctly placed epidurals and 33% in incorrect placement

The CompuFlo CathCheck system appears to accurately determine correct and incorrect epidural catheter placement for thoracic epidurals when compared to epidurogram

Neither physical examination nor meniscus testing appear to accurately reflect correct epidural catheter placement