The electrical properties of epidural catheters: What are the requirements for nerve stimulation guidance?

We designed the present study to investigate the electrical resistance of commercially available epidural catheters and to search for products and procedures suitable for nerve stimulation-guided insertion. Four types: of epidural catheters were evaluated: 2 nonwirereinforced catheters (19-gauge and 20-gauge nylon) and 2 wire-reinforced catheters (19-gauge without stylet. and 20-gauge with stylet). The resistance of a catheter was calculated from the voltage level proportional to the fixed resistance in series circuit. In case of physiologic saline, the resistance of nonreinforced catheters was more than 700 kΩ, whereas the wire-reinforced catheter was 14.4 ± 0.20 kΩ without stylet and 10.1 ± 0.42 kΩ with stylet. When the stylet was passed through a 20-gauge nylon catheter, the resistance decreased to 49.2 ± 1.96 kΩ. When catheters were primed with 10% hypertonic saline, the resistance of both nonreinforced catheters decreased by one third compared with physiologic saline. The electrical resistance of the saline-filled epidural catheters significantly differed among products tested. We conclude that epidural catheterization that is guided by electrical stimulation should be performed only with catheters equipped with spiral stainless steel wire reinforcement or with a stainless steel stylet.