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The BD Regional Anaesthesia Clinical Advisory Board Virtual Meeting was held on 23 – 24 July 2020 and was attended by anaesthetist and nurse representation from across Europe . The meeting focussed on the application of regional anaesthesia techniques and the implementation of the NRFit™ , an alternative to the standard Luer connectors for peripheral , intrathecal and epidural procedures .
This report summarises the key findings and recommendations .
Emphasis on education and training
Consider development of well-structured step-by-step curriculum
The Faculty first considered general inhibitors of a wider use of regional anaesthesia ( RA ), of which shortage of educational programmes , skills training and technical competence topped the list . Their perspective was that there was not a sufficient number of experts in the techniques , and that training of surgeons / anaesthetists / doctors might better be provided or supported by Industry .
One Faculty Member was able to cite the example of an ultrasound RA workshop that had succeeded in changing daily clinical practice in some countries , but that one- or two-hour workshops are not enough : you need a properly structured education programme . It was remarked that surgeons in the US may be viewed as blockers , because they perceive RA to be a time-consuming process , that impacts their ability to perform the surgery efficiently . Faculty recommended a well-structured curriculum with step-by-step , teach-the-teacher approach , with progressive implementation of different technical and level of knowledge and techniques , possibly involving cadaver training .
The discussion then moved to a focus on NRFit™ , beginning with an analysis of a systematic literature review of anaesthesia misconnections , and following with an introduction to ISO 80369-6 design standard for neuraxial applications connection ( NRFit™ ), the BD NRFit™ value offer , reflections on the current status of NRFit™ guidance and consideration of how to raise NRFit™ awareness .
Safe and secure neuraxial connections : a systematic literature review of misconnections Setting the scene for a Faculty discussion on NRFit™ , BD presented the results of a systematic literature review of neuraxial and peripheral nerve block misconnections reported in case reports between 1999 and 2019 . 1 As assigned by specific inclusion and exclusion criteria , the summary of findings was based on 72 papers reporting a total of 133 cases related to misconnections , rated in terms of severity . Misconnections relating to IV medication to epidural and intrathecal routes were the most frequent ( see Figure 1 ).
Factors contributing to connection-related injuries included the universal application of Luer adaptors , workarounds , stress / fatigue , environmental factors , failure to check or trace connections during patient transition and suboptimal reporting of adverse events or near misses .
Looking in detail at the number , severity and route of drug administration errors , caused by misconnection with more than two case reports we see that there were 24 reported deaths :
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FIGURE 1
Neuraxial and peripheral nerve block misconnections reported in case reports between 1999 and 2019 1
Epidural medication to IV route ( n = 38 )
IV medication to epidural route ( n = 38 )
IV medication to intrathecal route ( n = 33 )
PNB medication to IV route ( n = 17 )
References 1 Viscusi E . R ., Hugo V ., Hoerauf K ., Southwick F . S . Neuraxial and Peripheral Misconnection Events Leading to Wrong-Route Medication Errors : A Comprehensive Literature Review . Regional Anesthesia & Pain Medicine . 2020 in press
IV medication to extra / intraventricular route ( n = 4 )
Intramuscular medication to intrathecal route ( n = 1 )
Topical medication to intrathecal route ( n = 1 )
0 % 5 % 10 % 15 % 20 % 25 % 30 % 35 %