An unusual mid-shaft spinal needle defect detected accidentally.

Abstract

Sir, Spinal anesthesia is preferred for the caesarean sections for safety and ease. Use of Qiuncke type small bore spinal needle is recommended.[1] Through this letter, we are highlighting an unusual and very rare mid-shaft defect of Qiuncke spinal needle detected accidentally while injecting drug. A 26 G mm × 9.0 mm Qiuncke type spinal needle (Becton Dickinson) was inserted at the L2-3 interspace for spinal anesthesia. The subarachnoid space was easily encountered. Clear, spinal fluid was observed in the hub of the needle with removal of stellate. We had started injecting 0.5% hyperbaric bupivacaine through this standard and apparently normal looking needle after aspiration of spinal fluid. While injecting bupivacaine, we noticed drug drops were trickling from mid-shaft [Figure 1]. We checked needle hub and syringe attachment. To decrease drug wastage with forceful injection we injected at very slow rate around 1 ml/s. Half ml was estimated to have spilled from the mid-shaft defect. We had loaded a volume of 4 ml. We could easily inject the estimated intrathecal dose (3 ml). Very carefully we pulled back the needle (with due care that the defective needle could break). Caesarean section proceeded uneventfully. We closely scrutinized the 26 G spinal needle after use and could not find any visible split or crack. However, water was leaking from an area of mid-shaft while injecting. Figure 1 Spinal needle showing drug leaking through mid-shaft (1) while injecting. Another drop of drug on gloves (2) With extensive literature search, we got nearly similar article published in Anesthesia in 1991.[2] The letter was followed by an explanation from a medical unit of Becton Dickinson. The spinal needle is produced by pulling down a metal tube to the appropriate diameter.[2] The 26 G spinal needle is an extremely thin-walled needle. As far as needle bore size gets smaller the wall of the needle becomes thinner. While preparing needle, presence of any small particle near needle surface can cause a nick in the needle.[2] Any small nick can cause this type of defect. Through this letter, our concerns are mid-shaft defect in a disposable spinal needle is a very rare finding. An apparently normal looking needle may be the culprit. A slow rate of injection of anesthetic drugs can reduce drug spillage in such cases. The needle can break at its mid-shaft due to defect so utmost care is to be taken, while removal of the defective needle. Finally, an automated system to check the needle wall defect will help to reduce this type of needle defects.