Variations in epidural catheter manufacture: Implications for bending and stiffness

Background and objectives: There is no formal evaluation method used to relate epidural catheter design and manufacture to clinical outcomes, such as subarachnoid or intravascular catheter placement. We analyzed catheter bending stiffness to determine the range of stiffness of catheters commonly used. We hypothesized that catheter material has a greater influence on stiffness than does cross-sectional shape. Methods: We determined the elastic modulus by axial load testing and the area moment of inertia using calibrated microscopic measurements of cross-sectional geometry for 6 different catheter types, including 2 types of wire styletted catheters. We calculated bending stiffness as the product of the elastic modulus and the area moment of inertia. Results: Catheters had similar area moments of inertia, but markedly different elastic moduli. Nylon and polyurethane catheters had the same bending stiffness, which was twice as high as that of coil reinforced catheters (P < .05), but 35% lower than that of radiopaque catheters (P < .05). Nylon and radiopaque wire styletted catheters had similar bending stiffness, which were 23-fold to 90-fold greater than that of the nonstyletted catheters (P < .05). Conclusions: Catheters currently available establish the range of bending stiffness that should not be exceeded, only optimized to clinical outcome. Clinical studies are needed to correlate the incidence of unintentional intravascular or subarachnoid catheter placement or migration and bending stiffness. Catheter technology improvements may enhance safety and increase the likelihood of successful catheter insertion, maintenance, and removal.