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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

The Influence of Changing Epidural Needles on the Incidence of Epidural Complications: A Retrospective Impact Study

Abstract Number: F4D-2
Abstract Type: Original Research

Jessica C. Wrobel MD1 ; James J. Xie MD2; Lawrence C. Tsen MD3; Amber C. Benhardt MD4; Xinling Xu PhD5; Michaela K. Farber MD MS6

Introduction: Medication or supply shortage due to manufacturing delays is increasingly common, and its impact on practice and patient safety must be considered (1). The standard epidural kit on our labor and delivery unit became unavailable in November 2017, necessitating the introduction of replacement kits with different epidural needles. The purpose of this study was to evaluate the impact of a change in needle used for labor epidural techniques on the incidence of post-dural puncture headache (PDPH) requiring epidural blood patch (EBP).

Methods: Records of patients who received epidural analgesia for labor and vaginal delivery from July 1, 2015 through December 31, 2017 were reviewed. Outcomes prior to November 1, 2017 (standard group) were compared to November-December 2017 (novel group). The primary outcome was need for EBP for PDPH. Secondary outcomes included ≥ 4 attempts at epidural placement and dural puncture. Demographics including patient age, BMI, parity, gestational age, cervical dilation at time of placement, provider training level, and time of epidural placement (day or night) were compared. Categorical variables were compared using Fisher’s exact test. Continuous variables were compared using two-sample t test or Wilcoxon rank-sum test.

Results: A total of 45 of 8436 patients (0.532%) received an EBP for PDPH in the standard group, compared to 7 of 579 patients (1.205%) in the novel group (p=0.047, OR= 0.438, 95% CI=0.192-0.995). There was no difference in number of attempts (p=0.0534) or dural punctures (p = 0.1170) between groups. Patient characteristics and provider training level were similar between groups (p = ns).

Discussion: Caution must be exercised to minimize patient risk when different anesthesia supplies, such as epidural needles, are introduced. Our increased rate of EBP for PDPH upon introduction of an unfamiliar epidural needle is a cause for concern. Techniques such as neuraxial placement may be particularly sensitive to alterations in the type or quality of materials. For quality assurance, active surveillance to detect changes in complication rates is essential when medical shortages with product alterations or substitutions occur.

Reference

1. Fox ER. Am J Health-Syst Pharm. 2009; 66:1399–4



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