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Neuraxial anaesthesia: are we drawing up right? A quality improvement project

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Background and Aims: Techniques in regional anaesthesia should enforce sterility whilst maintaining prevention of arachnoiditis and meningitis as identified by the National Audit Project 3 (1, 2). Operating Department Practitioners (ODPs) should wear a facemask whilst assisting the Anaesthetist to prevent contamination from naso-oral flora (3). Chlorhexidine Gluconate (CHG) spray can travel after application and should not be used with exposed neuraxial needles (4). Filter needles should only be used unidirectionally and ampoules should be wiped (5, 6). Dead space should be factored into the draw up technique to avoid subtherapeutic doses of intrathecal opioid (7). Our quality improvement study aimed to assess local adherence to the recommended national and manufacturer published guidelines. Methods: Prospective data was collected over a period of 12 months from one district general hospital with single blinding. Practices and techniques pertinent to ODPs and Anaesthetists whilst drawing up drugs for imminent neuraxial blockade were documented during obstetric theatre sessions. Results: 23% of patients had their back sprayed with an open sterile tray. No ODPs wore a facemask and 11% opened glass ampoules without gloves, 89% with non-sterile gloves and none utilised sterile gloves or alcohol wipes to wipe the neck of ampoules after opening. Bi-directional (aspiration and injection) occurred with 51% of anaesthetists using a filter needle. Conclusions: Adherence to national and manufacturer recommendations was very poor with potential for subtherapeutic dosing of intrathecal opioid and subsequent implications regarding patient safety. Recommendations include education of ODPs and Anaesthetists via departmental events and posters to promote and improve awareness of ideal practice.

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© Copyright 2020 Morressier GmbH.
All rights reserved.