Complications related to intrathecal pump catheter infection

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.