Discussions for Module 12 : Aseptic Technique and Septic Complications of Regional Anesthesia

Questions are answered by module author: Dr. Sharon Davies MD FRCPC

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Question #3:

Good topic ! But the part missing was how about the regional blocks other than central neuraxial blocks . Especially when ultrasound guided regional techniques are getting more and more popular

1/6/2011 3:53:49 PM, S.S

Dr. Davies replies:

As for aseptic technique and peripheral blocks, there is not much literature out there on this topic. In fact, overall the aseptic technique literature is pretty new as the anesthesia world is starting to take notice that it is indeed an issue and that infectious complications are not as rare as we once thought. I would suggest that the principles of asepsis that have been outlined for central neuraxial blocks apply to peripheral blocks as well. These are principles of asepsis and, as such, should be applied to all sterile procedures as well as practice in general; for example, not touching the inner plunger of the syringe when drawing up solutions.


Question #2:

Please outline the various drugs and duration of contact with skin used before performing central neuraxil blockade.

3/6/2010 9:06:12 AM, Anonymous

Dr. Davies replies:

At our institution, we only use 2% chlorhexidine with 70% isopropyl for skin preparation prior to the performance of regional anesthesia. In regards to the actual skin contact time, the literature is in fact very vague. Consequently, I consulted our pharmacy and infectious diseases departments who were only able to state that, regardless of the product used, the recommendations are that one must use a sufficient quantity to wet the skin which must then be allowed to DRY. The key, in essence, is to let the product DRY naturally on the patient’s back. Of note, (recognizing the lack of evidence) our infectious disease department also suggests that we use 3 consecutive swabs for each patient.


Question #1:

In keeping with the notion of sterile solutions, what would be the best way to aseptically withdraw lidocaine from the polyamp seen in the video? Clearly, twisting the top off a polyamp results in the operator's hands touching the leurlock receptacle on the outside. As such, one should never screw on a leurlock syringe without the risk of contaminating the tip of the syringe. Expelling the solution by squeezing the polyamp may acutally cause solution at the end of the stream to contact the contaminated outside edge of the leur connector and cause contaminated drops to fall into the operator's receptacle. Perhaps the operator should use a sterile syringe and needle to aspirate the lidocaine from the polyamp followed by expelling the solution into the sterile receptacle.

2/20/2010 5:01:56 PM, J.E.T

Dr. Davies replies:

I agree that these polyamps can be an issue. I personally do not support attaching a syringe to the ampuole as this can possibly be contaminated when the nurse twists off the top as you describe. However, if one opens it with reasonable care, you can actually not touch the open leur lock end during the opening process. When I am personally drawing up solutions from these plastic amps I do use a syringe and needle instead of attaching the syringe. As for the inital lidocaine that the nurses pour into our epidural tray container, yes, one can indeed ask her to hold it for you to draw it up with a syringe and needle if you feel more comfortable with that technique. Perhaps the best answer is to make sure that our nurses are well trained not to touch the end that will be exposed once the vial is opened. The whole key to aseptic technique is to be aware of when and how contamination can occur so that we can minimize the possibility. Obviously, you are quite aware and have given a great deal of thought into how you conduct your own practice!

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