Mercy Hospital Peripheral Nerve Catheters

Updated December 6, 2014
Author: Sarah Laduzenski MD

Description: Guidelines for Placement and Troubleshooting, and Telephone Followup

For SMMC PNC Guidelines, click here

Patient Inclusion/Exclusion Criteria

  1. ASA<4
  2. BMI<41
  3. Still single shot only for patients with chronic opiate use (greater than 2 weeks)
  4. Still single shot for distance (with a caveat of a patient being willing to come back from the North Woods)
  5. Obviously no catheters for active infection, patient disinterest, etc.
  6. Of course, clincal judgement prevails in all circumstances

Placement Tips & Troubleshooting

  1. Consider shaving/clipping where the dressing will be placed, especially in MEN!
  2. When threading the stimulating catheter in the yellow connector (same connector as an epidural), consider dipping the catheter in the lidocaine to facilitate threading of the catheter.  The catheter can easily kink which prevents it from fully sliding into the connector.  If this happens, cut off the bent end with sterile scissors and try again.
  3. If there is air in the elastomeric pump’s tubing it will create an airlock.  If you have to remove this air, connect a 3-way stopcock and syringe to the connector at the end of the pump’s tubing and aspirate the air out.

Post-op Troubleshooting

Catheter-Removal Phone Calls

  1. A Followup Phone Call for Catheter Removal is necessary 48 hours after placement. For PN Catheters placed early on Monday-Wednesday, Danille is usually able to do this.
  2. For catheters placed late in the day, or on Thursday, the On-Call Doctor will make these calls. If there are calls to be made, you will receive an email with Patient Contact information.
    1. For example, a catheter is being placed right now at  2pm for a Pomeroy case. The pump will be connected in PACU (around 4pm) On Wednesday, that patient will need to be contacted sometime after 4 pm (assuming that the pump infuses for 48 hours 4pm plus 2-3 hours to allow for the block to wear off this will bring us to 6-7pm) and the caretaker will be talked through the removal process.
  3. You are strongly encouraged to use the PNC FOLLOWUP DOCUMENTATION FORM ( in MS Word format, so you can fill it out on a computer, electronically sign, and send it off). This is the way it works:

  4. Weekend Popliteal-Sciatic Catheter Follow-up Process and Documentation

    • Danielle will send a confidential, encrypted e-mail (CONFMSG in the subject line) to the on-call anesthesiologist responsible for the call.  It will include the patient's contact info, pertinent details about the catheter (including surgeon and inserting anesthesiologist), and the date to make a call
    • Attached to the e-mail will be a Word version of the progress note documentation form on which Danielle has entered the patient's name and account number (AH number)
    • The anesthesiologist will make the call, fill out the form (using Word), fill in the e-signature, and e-mail confidentially back to Danielle
    • The electronic signature will be in this format:
    "Electronically Signed by Anthony C. Miller, MD;   May 1, 2013   1332"
    • Danielle will print the document and send to HIM for filing
    • The same process will be used when Danielle is on vacation or leave and will apply to weekdays as well as weekends
    ◦ The physician placing the catheter will be responsible for sending the information to the regional doc or on-call doc who will make the phone call
    ◦ The electronic form will be available on the Spectrum website and
    ◦ The call anesthesiologist will have to enter the patient’s name and account (AH number)
    ◦ The completed documentation form will be e-mailed confidentially to Danielle who will file it upon her return
    When Danielle is away for extended leave, Dr. Miller will arrange for a Mercy employee to print and file the document
  5. If you need any help in figuring out what to say/ask, here is a suggested dialogue:
    1. "Hello. I'm Dr. Feelgood from Mercy Hospital. I'm calling you to assist in removing your catheter.  I will talk you or your caretaker through the removal process.  
      First, has the block worn off? Can you feel your foot and ankle? [If yes, continue. If not, plan for a call back to remove in a few hours]
      Next you will need to peel back the tape and clear plastic dressing that is over the catheter. 
      Now that the catheter is fully exposed, while holding counter pressure at the entry site, you will need to firmly but slowly pull the catheter out.  If you feel any electrical sensation down your leg while the catheter is being pulled out - stop pulling. It is normal to feel a "giving" sensation as some clots next to the catheter are released. [There may be some fibrous connections formed attached to the catheter]
      Once the catheter is out, is there a blue tip at the end that was inside of you? [If yes, you are done.
  6. If not, the catheter has sheared off and the patient will need a radiological/surgical evaluation.
    Have the patient bring all of the equipment/dressings/etc with him.  This is not an emergency and can be done the next day if there are no signs of infection - but use your clinical judgement].
    The patient can then throw the tubing/pump apparatus away.
    Danielle will call on POD 7 for another follow up."