Antiseptic solutions for central neuraxial blockade: which concentration of chlorhexidine in alcohol should we use?
نویسندگان
چکیده
Editor—We read the article on the national audit conducted by the Royal College of Anaesthetists by Cook and colleagues 1 and congratulate the group on an outstanding piece of work which has enlightened the whole anaesthetic community and no doubt will lead to improved patient safety. We note that the NAP3 audit reinforces that sterile technique in regional anaesthesia is an important aspect of reducing complications from infection of neuraxial blockade. In Chapter 9, it states that 'chlorhexidine in alcohol is the solution of choice for regional anaesthesia', although the concentration of chlorhexidine is not stated. A review article from 2006 also considered that its use be considered a Grade A recommendation. 2 A photo in the text shows a bottle of chlorhexidine 0.5% with alcohol 70% solution. In our trust, we have been using this chlorhexi-dine 0.5% with alcohol 70% solution for more than 14 yr without complication and understand the importance of letting the alcohol dry before attempting regional anaesthesia. As of 2008, some chlorhexidine-based topical cutaneous skin antiseptics have the warning 'do not use for lumbar puncture' or 'do not use in contact with the meninges'. In our trust, we have recently been asked to introduce Chloraprep w chlorhexidine 2% in alcohol 70% to use as a cleaning solution before spinal and epidural insertion rather than 0.5% with alcohol 70% after the recommendations of the EPIC study. 2 We are concerned that if the policy of using chlorhexidine 2% in alcohol 70% is introduced around the country that we may see an increase in complications of arachnoiditis secondary to chlorhexidine contamination. A recent publicized case of arachnoiditis due to chlorhexidine contamination was settled for £5 million with the suggestion that only chlorhexidine 0.1 ml was needed to cause the problem. Our concern is that with the introduction of higher concentrations of chlorhexidine solution, there will be more chlorhexidine residue left on the skin after the alcohol has dried. This may be introduced into the cerebrospinal fluid (CSF) on the tip of the spinal or epidural needle causing potential arachnoiditis secondary to chlorhexidine contamination. Can the authors please comment on whether they reached any conclusion after their audit on which concentration of chlorhexidine in alcohol is the safest antiseptic solution to use? Editor—We thank Dr Scott and colleagues 1 for their kind comments regarding the Royal College of Anaesthetists' 3rd National Audit Project (NAP3). Their primary point does …
منابع مشابه
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عنوان ژورنال:
- British journal of anaesthesia
دوره 103 3 شماره
صفحات -
تاریخ انتشار 2009