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Abstract
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Background and Aims UK safety alerts recommend the exclusive use of non-luer connectors for neuraxial and regional procedures. We recently transitioned from Luer to NRFit Portex/Smiths epidural kits. Following 2 successive cases of retained epidural catheter tip, we investigated alternative kits, aiming to review the commonly available brands of NRfit epidural kit and comparatively assess their design, utility and function.
Methods 1. Desktop analysis- Over 4 weeks in September 2022, obstetric anaesthetists performed an unblinded non-clinical desktop assessment of 4 NRfit epidural kits- Portex/Smith (24-1300-22), Pajunk (0331166-49), B.Braun 20G (4517309N-01) and Vygon (5191.601). The survey focused on needle, loss of resistance (LOR) syringe, catheter and filter/connector. 2. Medical physics analysis- A laboratory assessment comparing the physical properties of the kits (packaging, needle, stylet, needle wings, LOR syringe, catheter, filter/connector, ease of catheter shearing, and line pressures). 3. Clinical analysis- Based on the previous phases, 4 products including B.Braun 19G (4514025N-01) had each been clinically trialled for 4 weeks in obstetrics by January 2023 and were assessed on a follow up survey.
Grade of anaesthetist in desktop evaluation survey and clinical evaluation survey
Desktop evaluation
Clinical evaluation
Results 17 anaesthetists were surveyed in phase 1 and 9 anaesthetists in phase 3 of the project (figure 1). In the desktop (figure 2) analysis Portex/Smiths scored highly overall. Pajunk scored best overall in the medical physics analysis. Portex/Smiths and B.Braun 19G scored highly overall and were the preferred brands in the clinical (figure 3) analysis.
Conclusions No first generation NRfit kit is optimal, and all have design issues. Some issues are more tolerable than others and iterative design changes from all brands are eagerly anticipated.