Using the CompuFlo® CathCheck™ System to Check Epidural Catheter Function Before Tubal Ligation: A Pilot Study

Postpartum tubal ligation is a common surgical procedure performed after delivery, and labor epidural catheters are frequently used for anesthesia during this procedure. However, reactivation of labor epidural catheters after vaginal delivery can fail, requiring conversion to spinal or general anesthesia. Reported failure rates are significant, and factors such as prolonged time since delivery, prior need for additional epidural medication during labor, and poor analgesic satisfaction may increase the risk of failure.

Currently, there is no standardized method to confirm the continued function and location of an epidural catheter after childbirth and before reactivation for postpartum procedures. Standard clinical practice typically relies on catheter aspiration, epidural test dosing, and assessment of sensory blockade, but these methods may not reliably identify catheter dysfunction or migration.

This prospective pilot cohort study will evaluate the use of the CompuFlo® CathCheck™ System as an additional objective tool for assessing labor epidural catheter function before postpartum tubal ligation. The system uses computerized pressure measurements and pulsatile waveform detection to evaluate epidural catheter placement and patency. Study assessments will be compared with standard clinical evaluation methods to determine the ability of the device to identify functional versus dysfunctional epidural catheters.

The primary objective of this study is to assess the diagnostic accuracy of the CompuFlo® CathCheck™ System, including its sensitivity and specificity, in predicting successful epidural catheter reactivation. This study aims to determine whether incorporating objective pressure and waveform measurements can improve identification of catheter dysfunction, reduce failed epidural reactivation, minimize the need for additional anesthesia procedures, and enhance patient safety during postpartum tubal ligation.

• Sensitivity of the CompuFlo® CathCheck™ System [Time frame: Pre-procedural (prior to epidural reactivation)]
• Specificity of the CompuFlo® CathCheck™ System [Time frame: Pre-procedural (prior to epidural reactivation)]
• Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) of the CompuFlo® CathCheck™ System [Time frame: Pre-procedural (prior to epidural reactivation)]
• Number of Dermatomal Sensory Block Levels After Epidural Test Dose [Time frame: Periprocedural (at the time of labor epidural placement and at the time of epidural reactivation)]
• Duration of Labor Epidural Catheter Unused Time [Time frame: Periprocedural (from delivery until epidural reactivation)]
• Frequency of Labor Epidural Top-Up Doses [Time frame: Intrapartum (from labor epidural placement until delivery)]
• Postoperative Pain Intensity via Numeric Rating Scale (NRS-11) [Time frame: Periprocedural (upon admission to the post-anesthesia care unit [PACU] and at discharge from the PACU)]
• Patient Satisfaction Score With Labor Analgesia [Time frame: Periprocedural (prior to discharge from the post-anesthesia care unit [PACU])]
• Patient Satisfaction Score With Tubal Ligation Anesthesia [Time frame: Periprocedural (prior to discharge from the post-anesthesia care unit [PACU])]