Non-Luer neuraxial equipment and anaesthetists’ attitudes to change

Abstract

We read with interest the article and editorial concerning the testing and development of spinal and epidural needles with non-Luer connectors [1, 2]. The National Patient Safety Agency (NPSA) patient safety alert produced in 2009 requires neuraxial equipment connections to be incompatible with standard Luer connectors [3]. As there is no national agreed standard for the non-Luer connector, new purchasing pressures may develop within hospital trusts to standardise neuraxial equipment to one of a few suppliers. We recently surveyed consultant anaesthetists in the 11 trusts with a consultant-led maternity unit in the South West region regarding their attitudes to standardising equipment within and between trusts. Two anaesthetists were contacted in each trust: the lead consultant for obstetric anaesthesia and the lead for non-obstetric regional anaesthesia. The survey was answered either online or by email. We received 22 responses from the 11 hospital trusts, representing a 100% response rate. All trusts use Portex epidural needles (Smith Medical International Ltd, Ashford, Kent, UK). Spinal needles were supplied by the following manufacturers (number of responses): Vygon (11) (Vygon UK Ltd, Cirencester, Gloucester, UK), Polymedic (4) (Blue Box Medical Ltd, Southampton, UK), Becton Dickinson (5) (Becton Dickinson UK Ltd, Oxford, Oxfordshire), Pajunk (1) (Pajunk medical Products Ltd, Newcastle-upon-Tyne, UK) and Portex (1). Three trusts use different spinal needles for obstetric and non-obstetric anaesthesia. The NPSA has advised that trusts convene a multiprofessional implementation group to manage and introduce the changes required by the 2009 safety alert. Five of our trusts surveyed reported having a group with anaesthetic representation, four trusts did not have a group and respondents from two trusts did not know whether they had a group. The opinions of the surveyed anaesthetists are shown in Tables 1 and 2. There has been concern that the deadline for implementation of new spinal needles with non-Luer connections of 1st April 2011 is not achievable [4]. The NPSA have advised that in this situation, affected equipment should be placed on the trust risk register [5]. This implementation will be complex and require co-ordinated management. Our survey shows a clear majority of opinion, among consultant anaesthetists surveyed in the South West region, that standardisation of equipment is desirable for improving patient safety and benefitting trainees’ practice. This opinion applies both to a standard for epidural and spinal equipment and more strongly for all spinal equipment used by different physicians throughout each trust. There was also willingness to compromise on first choice of equipment in favour of standardising across the postgraduate training area. No external funding and no competing interests declared. Previously posted at the Anaesthesia Correspondence website: http://www.anaesthesiacorrespondence.com.