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ESRA19-0674 Neuraxial anaesthesia are we drawing up right? A quality improvement project
  1. S Ganesh1,
  2. L Tooley1,
  3. M Lohit2 and
  4. K Dasgupta3
  1. 1Warwickshire School of Anaesthesia, Anaesthetic Registrar, Birmingham, UK
  2. 2Northampton General Hospital, Anaesthetic Consultant, Northampton, UK
  3. 3George Elliot Hospital, Anaesthetic Consultant, EDRA, Nuneaton, UK


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 sub-therapeutic 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 sub-therapeutic 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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