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Evaluation of Epidural Trays for Microscopic Debris
Abstract Number: T-51
Abstract Type: Original Research
Introduction: The current practice of epidural placement employs the loss of resistance technique (LOR) with normal saline(NS) or air. To standardize the process, institutions purchase epidural kits which contain most of the needed
components. The kits contain material such as a label set, prep sponges, needle block foam, gauze, drape, paper towel, and packaging. The epidural trays are certified sterile, but no ascertainment is made whether they are “dustless” or free of debris. We have observed clinicians utilizing the wells of the epidural trays as a reservoir for NS to be used for the LOR technique.
Although, needle tips, medication ampules have been evaluated for bacterial contamination, the epidural trays, specifically the wells, have not been evaluated for bacterial or other contamination (1,2).
Methods: Five epidural trays were randomly selected from the L & D and operating suite at our teaching institution. The selection contained two lot numbers. Each tray was opened under a laminar flow hood. Sterile water (SW) was placed in two wells per tray from which 3 samples per well were obtained via sterile pipets. The samples were placed on sterile slides and sealed in sterile petri dishes prior to transport to pathology for microscopic examination. The SW was obtained from single plastic vials to eliminate the known risk of glass particles when drawing solution from glass ampules. All samples were collected in adherence with sterile compounding standards issued by the US Pharmacopeia.
Results: The study included 30 samples, of which 30 were found to have evidence of microscopic debris. Figure A-I represents 9 out of 30 samples.
Conclusion: This is a pilot study with a small sample size, however, all of the epidural kits we tested contained debris. Utilizing wells as a reservoir may lead to inadvertent introduction of such debris, in vivo. While the clinical implication of the introduction of these contaminants is not known, further evaluation of epidural kits and placement techniques should be considered.
1.C.J. Hemingway, S.M. Yentis. The effect of alcohol swabs and filter straws on reducing contamination of glass ampoules used for neuraxial injections. Journal of the association of anaesthetists of Great Britain and 2007; 62: 211-318
2.Raedler C, Lass-Florl C, Puhringer F, Kolbitsch C, Lingnau W, Benzer A. Bacterial contamination of needles used for spinal and epidural anaesthesia. Br J Anaesth 1999; 83: 657±8