Project Archive

Sterile Saline for Procedures

Crossover errors, such as the mixing sterile saline and chlorhexidine solutions in loss of resistance syringes during central neuroaxial blockade, can have disastrous consequences. There have been cases of paraplegia following accidental injection of chlorhexidine onto nervous tissues.

We performed a regional survey of practice in our deanery pertaining to the use and handling of saline for three sterile procedures:
 – Central venous catheter (CVC) insertion.
 – Theatre epidurals.
 – Epidurals for labour.

We questioned Consultants, Trainees and SAS doctors from seven hospitals, asking:
 – How is skin decontaminated?
 – How is saline for flush / LOR drawn up?

Our results show a large variation in the techniques used to sterilise skin for neuroaxial blockade, including some areas where risk of crossover between saline and chlorhexidine drawn-up into loss-of-resistance syringes was not adequately controlled for.