Do you need to use fluoroscopy when placing the intrathecal catheter?
Many physicians recommend that fluoroscopy be used during insertion of intrathecal catheters: difficult placement of the 15-gauge introducer at an acceptable angle and level cannot always be predicted preoperatively. Fluoroscopy facilitates placement. Return of cerebrospinal fluid (CSF) serves as evidence that a catheter is in the intrathecal space but provides no information about catheter tip location. Catheter tip placement through the neural foramina is also possible with poor delivery of drug and possible nerve root irritation. A badly coiled or misplaced catheter may allow CSF flow in the position of the patient in theatre but is subject to obstruction once the patient flexes and extends. These would not be evident without fluoroscopy. Once the catheter is placed contrast can be injected intraoperatively to assess for obstruction to CSF flow. At this time, only morphine and baclofen are approved for intrathecal use-both diffuse readily throughout CSF and catheter tip location doe
