epidurals in MRI

[MurseNeutron]

okie, yesterday i get a trauma patient from down range. female type. we extubate her in like the first 5 minutes of my shift. the anesthesiologist puts an epidural in the thoracic for pain relief on a broken left fibula head, broken left ankle, chest tube insertion for a hemothorax, left flail chest. anywho, c-spine is cleared by cat scan, but upon removal of the miami collar the pt is having tenderness with flexion to her chest.

the on call doctor orders an MRI of the cervical spine and a controversy insues over her eipdural. at first glance it looked as if though it was a catheter, but it appeared to be a wire inside the cath. threaded into the back. i am aware that a stylet is used for epidurals and is removed, but is a wire inside the cath? i have always called it a wire.

so, i call anesthesia back and they come over with no idea if it is a wire or not. the on call doc has no clue and neither does anyone else. we take the stock number of the type of epidural used, which is braun "perifix" continous epidural anesthesia tray and look it up with no results. now the box says that it is an opaque catheter with out any mention of a wire. it being opaque it shows up on x-rays, right.... finally the rad orders a Chest x-ray to determine, "how opaque the catheter is." yeah, nothing not even a shadow of the wire.

we call the head radiologist the results and he flips, of course, im sitting in the middle with the on call doc pressing it down my throat to get the mri; im not wanting to put my patient any where near a risk with an mri that could burn the hell out of her, not to mention, the wire is stuck in her spinal column.... anywho, the radiologist comes in fussing about not being sure and not wanting to do it, which in the evil end wasted my time because i told the two they needed to figure it out which, of course, ended up us not getting the mri done in the end. im just curious has anyone else taken a patient to MRI with an epidural? whats the scoop on it? is it a wire or just a metal looking cath? arn't they opaque? any protocols?? hit me up.

[augigi, CNS]

I hope you don't take my word for it - you should read the manufacturer's product literature, which will clearly state if the product is not MRI-compatible.

From the manufacturer website: http://www.bbraun.com

"A common feature of all Perifix® catheters versions is the use of a well proven proprietary medical grade polyamide material providing the following benefits:

■ free of plasticizers, implantation tested

■ stretch-resistant and high tensile strength

■ crystal clear, easy visualisation of blood or CSF

■ excellent shaft stability, easy placement, no need for any additional metal stylet or coil

■ virtually no risk of forming a loop or knot

■ within a few hours the catheters softens by about 40% due to water absorption to the polyamide material"

It appears there is not even a guidewire in the Perifix kits.

[jewelcutt]

I have never used a wire in placing an epidural nor would I ever think to because of inadvertent dura puncture, the catheter is threaded through the needle. The catheter itself is not made of any metal that I know of.