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SUSPECTED EPIDURAL HAEMATOMA AND SURGICAL CLIPS - CASE REPORT
Author(s):
KUPPUSWAMY MOHANRAJ, A.*
Affiliations:
, Wigan, United Kingdom
ESRA Academy. K Mohanraj A. Sep 13, 2017; 190757; 421 Topic: SAFETY AND COMPLICATIONS OF REGIONAL ANAESTHESIA (RA)
Dr. Arun K Mohanraj
Dr. Arun K Mohanraj

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Abstract
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Background and Aims:

A 74 year old female patient with  2nd revision hip replacement with an epidural catheter in situ developed symptoms suggestive of epidural haematoma on the 3rd post operative day. With surgical clips in place at the operated site MRI scan of the spine was delayed due to concerns of surgical clips displacement and heating under the MR scanner. MR scan was performed later that evening after contacting the surgical clip company for MR safety. 

Methods:

Literature search was initiated after deciding the search words and performed in Pubmed and EMBASE .Results were de duplicated using RefWorks. 

Results:

1. Most of the surgical skin clips currently in use are either non ferromagnetic or least ferromagnetic and are deemed safe during MR scans as long as the strength of the MR scanner is less than 3TESLA.

2. The Medicines and Healthcare products Regulatory Agency (MHRA) has produced guidelines recommending that hospitals must make provisions for correct identification, documentation, imaging and aftercare for patients with implantable medical devices requiring MRI scanning [2]. These are updated annually. These are as follows

3. No case reports (15 years search period) were identified pertaining to surgical clips causing tissue damage or migration under MR scanner.
4. At least 5 case studies were found testing different skin clips effect under MR scanner (3 with 1.5 TESLA and 2 with 3 TESLA) and results were reported safe.

Conclusions:

Established hospital guidelines on surgical clips should be in place to minimise the delay in patient situations which might have negative impact on patient outcomes.

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