© 2003 International Neuromodulation Society, 1094-7159/03/$15.00/0 Neuromodulation, Volume 6, Number 1, 2003 32–41 Blackwell Publishing Ltd. Prevention of Intrathecal Drug Delivery Catheter-Related Complications Kenneth A. Follett, MD, PhD*,  Kim Burchiel, MD † ,  Timothy Deer, MD ‡ ,  Stuart DuPen, MD § ,  Joshua Prager, MD, MS ¶ ,  Michael S. Turner, MD**,  Robert J. Coffey, MD †† *University of Iowa Hospitals and Clinics, Iowa City, Iowa; † Oregon Health Sciences University, Portland, Oregon; ‡ The Center for Pain Relief, Charleston, West Virginia, § Swedish Hospital Pain Management, Seattle, Washington; ¶ University of California at Los Angeles School of Medicine, Los Angeles, California; **Indianapolis Neurosurgical Group, Indianapolis, Indiana; †† Medtronic, Inc., Minneapolis, Minnesota  ABSTRACT In an effort to improve the performance of implantable intrathecal drug delivery systems, a group of physicians experienced in the management of such devices reviewed surgical practices and principles that were associated with low catheter-related complication rates. Clinical study and postmarket data identified physicians whose patients experienced a relatively low rate of catheter-related complications. Six of those physicians (three anesthesiologists and three neuro- surgeons) reviewed the number and types of intra- thecal drug pumps and catheters they had implanted, with an emphasis on the specific details of successful catheter implantation techniques. The authors pooled their experiences to reach a consensus on implant techniques that are associated with a low rate of post- operative complications. The authors found that complications were mini- mized by the use of specific methods for catheter placement that included: a mid-to-upper lumbar dural entry level, a shallow-angle paramedian oblique inser- tion trajectory, and meticulous catheter anchoring and tunneling techniques. Systemic antibiotic prophylaxis, attention to pump pocket location, and surgical wound closure techniques also were important in reducing the incidence of postoperative device- related complications. Their experience indicates that specific implantation techniques using a variety of catheters and accessories can be expected to reduce the incidence of complications after implantation of intrathecal drug administration systems.  KEY WORDS: drug administration system, intrathecal catheter, intrathecal drug delivery, pain, pump, spasticity. INTRODUCTION Background and Scope Intrathecal drug delivery using fully implantable pumps and catheter systems has been used since the 1980s to treat chronic intractable pain associated with cancer or nonmalignant causes (1,2). Pro- grammable systems to administer intrathecal baclofen The consensus conference upon which this manuscript is based was supported by an unrestricted educational grant from Medtronic, Inc., Minneapolis, MN. Address all correspondence and reprint requests to: Kenneth A. Follett, MD, PhD, University of Iowa Hospitals and Clinics, Department of Neurosurgery, 200 Hawkins Drive, Iowa City, IA 52242. Email: kenneth-follett@uiowa.edu.