Abstract
Intrathecal pumps offer tremendous utility in treating chronic pain. Patients with intractable pain, mental status changes, or inability to tolerate oral opiate medication often see their lives transformed after placement of an intrathecal pump (ITP). It wasn’t until 1981 when the first intrathecal opiate delivery system was clinically tested for management of chronic cancer-related pain. As of 2013, more than 300,000 intrathecal pumps have been implanted for chronic pain or spasticity. While intractable chronic pain and cancer pain are frequent indications for ITPs, the most common indication is failed back surgical syndrome (Hayek SM, Deer TR, Pope JE, Panchal SJ, Patel V. Intrathecal therapy for cancer and non-cancer pain. Pain Physician. 2011;14:219–48). The ultimate success of an intrathecal pump rests in proper patient selection. Complications related to ITP are divided into four main categories: device malfunction, medication error, procedural mishaps, or catheter related. The leading source of complications involves catheter infections or catheter migration. Meningitis is the most devastating of all the complications. Good surgical technique and hypervigilance may significantly reduce these risks. Cancer patients are especially susceptible to infectious complications as they are often immunocompromised and malnourished and are exposed to cytotoxic chemotherapeutic agents.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Follett K, Boortz-Marx R, Drake J. Prevention and management of intrathecal drug delivery and spinal cord stimulation system infections. Anesthesiology. 2004;100:1582–94.
Deibert C, Gandhoke G, Forsythe R, Moossy J. Surgical site infection 18 months following intrathecal pump placement secondary to an asymptomatic bowel injury. Pain Pract. 2015;15(7):E69–71.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. The hospital Infection Control Practices Advisory Committee. National Center for Infection Diseases. Centers for Disease Control and Prevention. Public Health Service. U.S department of health and Human Service. 1999.
Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinber JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm. 2013;70:1995–283.
Garabaldi RA. Prevention of intraoperative wound contamination with chlorhexidine shower and scrub. J Hosp Infect. 1988;11:5–9.
Seropian R, Reynold BM. Wound infections after preoperative depilatory versus razor preparation. Am J Surg. 1971;121:251–4.
Darouiche RO, Wall MW, Itani KMF, Otterson MF, Webb AL, Carrick MM, Miller HJ, Awad SS, Crosby CT, Mosier MC, Alsharif A, Berger DH. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med. 2010;362:18–26.
Deer TR, Mekhail N, Provenzano D, Pope J, Krames E, Thomson S, Raso L, Burton A, De Andres J, Buchser E, Buvanendran A, Liem L, Kumar K, Rizvi S, Feler C, Abejon D, Anderson J, Eldabe S, Kim P, Leong M, Hayek S, McDowell G, Poree L, Brooks E, McJunkin T, Lynch P, Kapural L, Foreman RD, Caraway D, Alo K, Narouze S, Levy RM, North R. The appropriate use of neurostimulation: avoidance and treatment of complications of neurostimulation therapies for the treatment for chronic pain. Neuromodulation. 2014;17:571–98.
Ayliffe GA. Role of the environment of the operating suite in surgical wound infection. Rev Infect Dis. 1991;213:1189–91.
Dipaola CP, Saravannja DD, Boriani L, et al. Postoperative infection treatment score for the spine (PITSS): construction and validation of a predictive model to define need for single versus multiple irrigation and debridement for spinal surgical site infection. Spine J. 2012;12:218–30.
Prager J, Deer T, Levy R, Bruel B, Buchser E, Caraway D, Cousins M, Jacobs M, McGlothen G, Rauck R, Staats P, Steans L. Best practices for intrathecal drug delivery for pain. Neuromodulation. 2014;17:354–72.
Malheiro L, Gomes A, Barbosa P, Santos L, Sarmento A. Infectious complications of intrathecal drug administration systems for spasticity and chronic pain: 145 patients from a tertiary care center. Neuromodulation. 2015;18:421–7.
Zed PJ, Stiver HG, Devonshire V, Jewesson PJ, Marra F. Continuous intrathecal pump infusion of baclofen with antibiotic drugs for treatment of pump-associated meningitis. J Neurosurg. 2000;92(2):347–9.
Bennett MI, Tai YMA, Symonds JM. Staphylococcal meningitis following synchromed intrathecal pump implant: a case report. Pain. 1994;56:243–4.
Engle M, Vinh B, Harun N, Koyyalagunta D. Infectious complications related to intrathecal drug delivery system and spinal cord stimulator system implantation at a comprehensive cancer pain center. Pain Med. 2013;16:251–7.
Provenzano DA, Deer T, Phelps AL, Drennen ZC, Thomson S, Hayek SM, Narouze S, Rana MV, Watson TW, Buvanendran A. An interventional survey to understand infection control practices of spinal cord stimulation. Neuromodulation. 2016;19:71–84.
Anderson DJ, Kaye KS, Classen D, Arias KM, Podgorny K, Burstin H, Calfee DP, Coffin SE, Dubberke ER, Fraser V, Gerding DN, Griffin FA, Gross P, Klompas M, Lo E, Marschall J, Mermel LA, Nicolle L, Pegues DA, Per TM, Saint S, Salgado CD, Weinstein RA, Wise R, Yokoe DS. Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(suppl 1):S51–S61.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Beckerly, R. (2018). Complications Related to Intrathecal Pump Catheter Infection. In: Anitescu, M., Benzon, H., Wallace, M. (eds) Challenging Cases and Complication Management in Pain Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-60072-7_28
Download citation
DOI: https://doi.org/10.1007/978-3-319-60072-7_28
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-60070-3
Online ISBN: 978-3-319-60072-7
eBook Packages: MedicineMedicine (R0)