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Temporary Epidural Catheter Placement

 

What is an implanted epidural portal?

An epidural portal (or port) is an implanted device which allows access to the epidural space in your spine. It is used for the delivery of medications for pain management. A port is a small, stainless steel disc (about the size of a half dollar) with a raised “septum” in the center. Because the section is raised, it is easily felt through the surface of the skin. The port is usually implanted under the skin on the chest. Attached to the base of the port is a narrow flexible tube, called a catheter. The catheter runs beneath the skin from the epidural space in the space around to the front of the chest where it is attached to the port. Since the entire device is placed under the skin, the risk of infection is greatly reduced. The septum is made of a remarkable, self-sealing rubber material. Over years of use, the septum may be punctured many hundreds of times and reseals itself instantly after use. This procedure is done only after a trial of epidural medications has been proven to be useful in managing your pain.

How quickly can I expect pain relief?

Once the epidural port is placed, an infusion of medications (local anesthetics and/or narcotics) is initiated. These medications should bring about pain relief within minutes. It may, however, take a few days to adjust the dose for the optimal pain relief.

How should I prepare for the procedure?

The implanted epidural portal placement is a safe medical procedure; but, as with any procedure, it has risks as well as benefits. To minimize the chance of complications, we ask that you follow a few simple guidelines:
Do not eat or drink anything for 6 hours prior to the procedure.
Following placement of the epidural portal you will be required to stay overnight for observation.
We require that you be accompanied to and from the Advanced Pain Institute by a responsible adult driver.

What happens during the procedure?

First, an intravenous line will be placed, generally in your hand. We will then bring you to the operating room and place several monitors on you, such as a heart, blood pressure and a pulse monitor. These will enable us to monitor your vital signs throughout the procedure. Following placement of the monitors we will begin to give you some intravenous medication in order to decrease anxiety, as well as provide you with some pain relief.
Your back will be cleaned and the insertion point of the epidural port will be anesthetized with local anesthesia. The epidural needle is placed through a small incision in your back and the catheter is threaded through the needle under the guidance of X-ray. A second small incision is made on the upper part of your chest wall and a pocket is created in the tissues beneath the skin. The small circular epidural port is inserted into this pocket and connected to the catheter which is tunneled underneath the skin from you back. The two incisions, on the chest wall and on your back, are closed with stitches and both are dressed with a sterile dressing. The port is then accessed with an access needle and connected to an external infusion pump containing the epidural medications. The epidural port will be functioning before you leave the surgical suite to provide you pain relief.
A majority of this procedure is performed under a local anesthesia, thereby providing minimal discomfort at the time of the surgery, and also providing pain relief for 6 to 12 hours afterwards. You will also receive sedation to provide optimal comfort during the procedure.

What happens after the procedure?

Once the port is placed, it will be accessed with a special needle and connected to an external infusion pump containing the epidural medications. We will assess that the port is functioning correctly by observing for signs of pain relief from the medications, as well as development of numbness from the local anesthetic. You will be monitored for 20 to 40 minutes by a recovery room nurse and a pain management physician. If there are no signs of problems, you will be ready to leave the recovery area and be transferred to your room in the Advanced Pain Institute for overnight observation. You will be monitored for proper functioning of the newly placed epidural port, as well as for any complications related to the procedure and the anesthesia. If there are no further difficulties, you will be released the following day.
A home nursing agency will be required to provide care for your epidural port. The medication cassette will need to be changed daily. The dressing, needle, and the infusion tubing will need to be changed every three days by a home visiting nurse. The visiting nurse will also monitor for any possible signs of infection.
Your port will be dosed with medications on either an intermittent or continuous basis based on the determination of the pain management physician.

Will my insurance cover the procedure?

The implanted epidural portal is a well established medical procedure and is reimbursed by most insurance companies. Any need for preauthorization of services or copayments depends on your insurance carrier. Our office staff will assist you in obtaining preauthorization whenever possible.

What should I expect from this procedure?

You will require a short period of recovery from this minor surgical procedure. You may notice soreness in the chest wall where the epidural port is placed and some soreness in the back where the catheter is inserted; the pain is usually quite minimal. There will be some bruising which may last up to a week, but will resolve. Your home nursing agency will assist in monitoring the two sites for any evidence of infection. Signs to monitor are redness and/or increased pain or swelling of the two incision sites. The stitches will be removed at the Advanced Pain Institute in approximately one week, provided that the incisions are well healed.

What possible side effects might I see?

The epidural portal placement is a safe minor surgical procedure but, as with any procedure, it has risks as well as benefits. The major risks of an in dwelling foreign device are infection and/or local bleeding. Usage of such a device over the long term requires vigilance to maintain clean technique and decrease the likelihood of infection.
The epidural portal accesses the epidural space. The medications delivered there may cause numbness and/or weakness and/or sedation depending on which medication is used and what dose is administered. These side effects are normally reversible. You may have some local tenderness at the portal insertion points once the numbing medicine has worn off.

What should I do if any problems develop after I leave the hospital?

If you have any questions after the procedure, the medical staff of the Advanced Pain Institute is on call 24 hours a day, 7 days a week. You can reach either the nurse or physician by calling (626) 445-2371.

Post procedure instructions

Prior to leaving the hospital, the incision areas will be dressed with a clear, dry sterile dressing. You will be able to see through the dressing and can watch for any signs of infection. The visiting nurses will change the access needle and tubing for the infusion pump every three days. They will also monitor to make sure the wounds are healing appropriately.