Optimizing Continuous Catheter Use in Regional Anesthesia: Balancing Efficacy and Safety

An update from ASRA Pain Medicine offers a structured approach to catheter duration and monitoring that balances effective analgesia with infection risk for continuous peripheral and neuraxial catheters. The guidance stresses individualized duration and notes that most catheters are safe for 3–5 days with careful monitoring.

Where previous practice often relied on arbitrary time limits, the new guidance prioritizes individualized assessment and active surveillance. Patient risk factors such as immunosuppression, device location, wound contamination should prompt earlier removal or intensified monitoring. The guidance reframes management from fixed cutoffs to dynamic, daily decisions informed by patient- and process-level risk.

The update identifies a typical safe window of 3–5 days for most catheters when close monitoring is in place. Because infection risk rises with dwell time but is strongly modulated by patient factors and insertion and dressing quality, duration must be interpreted in context. Daily checks should include inspection of the insertion site, routine vital signs and pain scores, assessment of catheter function, and predefined escalation triggers for suspected infection or loss of efficacy.

Prevention depends on strict sterile technique at insertion and during maintenance: full sterile barriers at insertion, 2% chlorhexidine–alcohol skin preparation with adequate dry time, transparent sterile dressing and securement to reduce migration, and limiting catheter manipulation. Checklists and standardized dressing-change intervals reduce variability and help teams detect early breaches. Together, these measures support safe extension of catheter use when clinically justified and closely monitored.

Prolonged externalized catheter use is appropriate in select contexts—burn care or cancer pain—but requires clear analgesic benefit and explicit safeguards. The update recommends documented daily benefit–risk assessments, a lower threshold for imaging or culture when infection is suspected, and multidisciplinary review for continued use beyond routine periods.