NPSA Safer spinal, epidural and regional devices
Contents of this page
NPSA Alerts / Documents and communications / NPSA newsletters / Published evaluations
Currently it is possible to inject drugs intended for intravenous administration into the spinal or epidural space and conversely to inject drugs intended for spinal, epidural or regional nerve block via the intravenous route. This has occasionally resulted in fatalities and continues to feature in patient safety incident reports.
The NPSA wished NHS organisations to change to equipment with non-Luer connections over the next few years; spinal equipment by 1st April 2012 and epidural and regional equipment by April 2013. From April 2012 “all spinal (intrathecal) bolus doses and lumbar puncture samples are performed using syringes, needles and other devices with safer connectors that will not connect with intravenous Luer connectors”.
National Patient Safety Agency Alert NPSA / 2009 / PSA004A&B - "Safer spinal (intrathecal), epidural and regional devices"
Safer spinal (intrathecal), epidural and regional devices - Part A: update - Click here to view
(31 January 2011) - 574 KB
Safer spinal (intrathecal), epidural and regional devices - Part B - Click here to view
(24 November 2009)- 201 KB
Documents and Communications
NHS Pharmaceutical Aseptic Services Group (June 2013):
1.2 How should the new devices be introduced into clinical practice in my hospital?
1.3 What degree of training is necessary before clinicians start using Alert-compliant devices?
1.4 Can’t this work be undertaken nationally or regionally?
1.5 What is the status of combined and epidural kits (CSE)? Are they covered by NPSA Part A or Part B guidance?
1.6 What is the status of Loss of Resistance Syringes (LOR) are they covered by Part A or Part B guidance?
1.8 I understand that the International Standards Organisation (ISO) is developing an international standard for neuraxial connectors, how will this affect the NPSA guidance?
2.2 Are Ommaya reservoirs covered by NPSA guidance?
2.3 Neuro-endoscopes have Luer connectors for connection directly to giving sets so saline can be irrigated into the ventricles during the operation. Guidance please?
2.4 The NPSA Alert stated ‘eliminate the use of three-way taps and adaptors with Luer connectors, which enable connection of specified devices to intravenous devices’. Please clarify exactly what is meant by this guidance?
2.5 Is sub-tenon anaesthesia covered by the alert, and if so which part of the alert covers it?
2.6 How should the epidural blood patch technique be undertaken with safer neuraxial devices in the future?
2.7 Are Bier’s Blocks covered by the Alert?
2.8 What are the definitions for regional and local anaesthesia used by the NPSA?
2.9 The NPSA Alert states that neuroaxial devices with safer connectors should not connect with intravenous Luers. Does this include all possible cross connections?
2.10 Should safer connectors, used in neuroaxial devices, connect with needle free connectors and bi-connectors used in intravenous devices?
2.11 Should syringes and needles used to administer local anaesthetics into the skin have safer connectors?
There is some confusion over the product range required to implement NPSA Alert Part A guidance, i.e. a recommended product range available for information?
Read the NPSA's Rapid Response Report of 28 November 2011
FAQs in Issue 3
3.1 Are spinal catheters covered in part A or B of the NPSA Alert?
3.2 Are winged needle infusion (Butterfly) devices with non-luer connectors necessary to achieve compliance with the NPSA alert?
3.3 In my orthopaedic practice, I use a spinal needle to aspirate the knee joint. What do I need to do in April 2012?
3.4 Is local anaesthetic wound infusion devices covered by Part B, or is it outside the NPSA alert?
3.5 Which suppliers are supplying short spinal needles with safer connectors suitable for use with children?
3.6 Is there a requirement for tamper evident syringe caps to meet the NPSA Alert requirements?
FAQs in Issue 4
4.1 Are winged needle infusion (Butterfly) devices with non-Luer connectors necessary to achieve compliance with the NPSA alert?
4.2 Are 1 ml, 10 ml, and 20 ml syringes required for Part A recommendations?
FAQs in Issue 5
Are the following clinical procedures covered by NPSA neuraxial connector guidance?
5.1 Facet joint injection
5.2 Lumbar sympathectomy
5.3 Trigeminal ablation
5.4 Suprascapular nerve block
5.5 Peripheral nerve block
5.6 Regional nerve block
5.7 Can the new devices be used to store aseptically prepared medicines from hospital pharmacies or commercial compounding units?
Evaluations of non-Luer spinal equipment:
And accompanying correspondence from Brian Toft and David Cousins Anaesthesia 2013; 68:426 and response Kinsella et al. Anaesthesia 2013; 68-426
Ahmed et al. International Journal of Obstetric Anesthesia 2013:22:S14 - BD / Smiths-Portex / Vygon / BBraun / Pajunk
Bhalla et al. International Journal of Obstetric Anesthesia 2013:22:S33 - Flexicare Hall Lock / Pajunk Surety / Transmed Surety / Neurax B-Link / Smiths CorrectInject / BD UniVia
Rao & Singh. Survey on the usage of non-luer spinal needles: departmental experience and opinion. OAA Annual Meeting poster, Bournemouth. 2013.