Many patients being admitted to the intensive care unit (ICU) after thoracic surgery will have both epidural and pleural catheters for postoperative pain control. The epidural catheter will usually be attached to a patient-controlled analgesia (PCA) device with both a continuous and a demand dose; pain medication administered via a pleural catheter is usually given as a continuous infusion.

This can be an area of potential confusion for ICU staff because epidural and pleural catheters often look identical; a pleural catheter is usually a catheter taken from an epidural kit and inserted into the pleural space. In addition to the identical appearance, the epidural and pleural catheters may be positioned next to each other and covered with dressings, making it extremely easy for the nursing staff to mistake one catheter for the other. To avoid this confusion, the epidural and pleural catheters should be clearly marked near the site of injection.

Given the mistakes that have occurred with epidural and intravenous (IV) catheters, such as inadvertent IV administration of bupivacaine intended for an epidural catheter or the epidural administration of potassium or lipid emulsion, it is mandatory that meticulous care should also be used when dosing epidural and pleural catheters. One drug that is particularly problematic if it is administered in the wrong catheter in the wrong dose is bupivacaine, which is a local anesthetic used in both epidural and pleural catheters for postoperative pain control. Bupivacaine works by binding to the sodium channel of a nerve cell and preventing propagation of the nerve impulse along the cell membrane. It then dissociates very slowly from the sodium channel.