Rathmell's FDA Safe Use Recommendations for Epidural Injection

[Dr Manhattan]

This is a multi-disciplinary project that involved 13 societies regarding epidural steroid injections. Recommendations were presented to the FDA, which may change the way we practice.

Thoughts and opinions? I use dexamethasone for L3-4 and above, Celestone for the rest. Do not wear a mask in the procedure room (did a trial of it recently then discontinued)

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[lobelsteve]

As soon as it was published i called a meeting with staff and admin and put in signs and mask dispensers. It is now official and masks are required.

 

[101N]

I put on a mask while I read it.

 

[specepic]

you guys are kidding about not using masks previously I assume?

 

[willabeast]

i always wear masks. and goggle type glasses. but...one time i found an eyelash on my open spinal tray. :-(

 

[lobelsteve]

you guys are kidding about not using masks previously I assume?

Nope. Only in ASC and OR. Never in office. Andvthat was since acgme fellowship training at Emory.

 

[emd123]

I've always worn a mask. This is not even a big deal. Wear a mask. Costs 5 cents and keeps boogers from falling out of your schnoz into your sterile field. It's a win win

Also keeps patient smell out

Triple WIN!

 

[clubdeac]

I now wear a mask out of habit but really think it does nothing. It's the least beneficial thing we could do to prevent infections.. unless you have chronic bronchitis or something

 

[101N]

http://www.cdc.gov/injectionsafety/SpinalInjection-Meningitis.html

 

[lobelsteve]

http://www.cdc.gov/injectionsafety/SpinalInjection-Meningitis.html

And it also states:

For other spinal procedures (e.g., diagnostic and therapeutic lumbar punctures) or handling of devices to access the cerebrospinal fluid (e.g., Ommaya reservoir), there is limited evidence of a similar risk. At a minimum, healthcare personnel should use aseptic technique and follow safe injection practices (e.g., dedicating single-dose vials to single-patient use) for these procedures; a facemask can be considered as an additional precaution.


The cases of meningitis were in a hospital or in outpatient imaging center with myelograms being performed.

 

[Ducttape]

ASRA and ASA guidelines have strongly recommended mask use since, well, at least since 2010.

 

[SSdoc33]

eff this. i really hope the clipboard nurses dont catch wind of this article. i really dont want to have to wear a mask. what, are we going to scrub in and wear gowns now? c'mon.

is there really a difference between doing a MBB and an epidural in regards to infection risk?

so far i am 0 for 10,000 on infections (knock on wood) without wearing a mask. have any of you ever had a legimate epidural abscess that cane be directly traced from an epidural?

also, i semi-routinely find my wife's hairs on my "sterile" field. dont ask me how they got there.

 

[lobelsteve]

The recommendations only apply to ESI and SCS, but would argue that only SIJ, joints, and MBB/RF do not need masks.

 

[miamidoc2b]

rathmell - isn't this the same guy that sent me an email about aba not changing moca? stand-up tax paying citizen of peace...

 

[miamidoc2b]

eff this. i really hope the clipboard nurses dont catch wind of this article. i really dont want to have to wear a mask. what, are we going to scrub in and wear gowns now? c'mon.

is there really a difference between doing a MBB and an epidural in regards to infection risk?

so far i am 0 for 10,000 on infections (knock on wood) without wearing a mask. have any of you ever had a legimate epidural abscess that cane be directly traced from an epidural?

also, i semi-routinely find my wife's hairs on my "sterile" field. dont ask me how they got there.

hmmm "hair" - if you tell us the length of such object, we can further provide recommendations on how to proceed

 

[SSdoc33]

hmmm "hair" - if you tell us the length of such object, we can further provide recommendations on how to proceed

it was her head hair, miami. get your mind out of the gutter!!!!

 

[Ducttape]

are you sure?

do you have a mechanism of determining the origin of said "hair"?

 

[specepic]

I don't wear a gown but I do a scrub from fingers to elbows prior to case #1, then avagard in b/t cases after that. Mask at all times for all fluoro (required by hosp for OR). I dont mind at all. I also mask for large joint inj's under U/S at office. Takes 2 sec. Shows pt I take procedure seriously.

For ESI all should mask, others optional IMHO

 

[clubdeac]

I now wear one of those orthopedic space suits with an internal fan for all procedures. Makes me look more improtant

 

[geauxg8rs]

We had a retired rn as a patient who flipped out that our sedation nurse wasnt wearing gloves while he wrote his chicken scratch notes.
I unknowingly unearthed the problem when I walked into the procedure suite and saw him wearing gloves and said "why the f*** are you wearing gloves!?

 

[NJPAIN]

Patients equate a mask with sterility. Since the CDC recommendations came out several years ago I take the time to put a mask on.

 

[epidural man]

I usually don't wear a mask - I guess I better now.

But rather than a lot of people that think they are really important saying things that they "think" is a good idea - like the nurses running around saying you can't wear long sleeves in the OR - is there any data to show a mask does ANYTHING? Any data whatsoever?

There was a case report - or maybe a report in coffee table magazines - of an OB patient getting an abcess after a catheter placement and the bacteria matched the oral flora of the anesthesiologist - but other than that?

 

[epidural man]

In fact, I have heard mask are more dangerous because people wear the same mask all day. Those things become filthy.

 

[epidural man]

Rathmell is starting to irck me - especially after he defended the money sucking MOC. That's borderline ******ed. Maybe he is ******ed. Has someone checked his grades he got?

Seriously...if you defend MOC - you either have no brain, can't think properly, or are very dishonest person. There is no other explaintion.

 

[Ducttape]

In fact, I have heard mask are more dangerous because people wear the same mask all day. Those things become filthy.

Masks are supposed to be changed between patients or after (I believe) something like 4 hours of use.

Standard anesthesiology training... Maybe another unique aspect anesthesia brings to pain...

The old timers often support MOC. Because it sounds good and esp since they don't have to do it...

 

[drrosenrosen]

The old timers often support MOC. Because it sounds good and esp since they don't have to do it...

Ding ding ding! Winner!

 

[bedrock]

I usually don't wear a mask - I guess I better now.

But rather than a lot of people that think they are really important saying things that they "think" is a good idea - like the nurses running around saying you can't wear long sleeves in the OR - is there any data to show a mask does ANYTHING? Any data whatsoever?

There was a case report - or maybe a report in coffee table magazines - of an OB patient getting an abcess after a catheter placement and the bacteria matched the oral flora of the anesthesiologist - but other than that?

There is just a couple cases reports, no real data.

I've never had an infection, but recently after ISIS and almost every other society recommended them, I gave in and started to put on a fresh mask for ESI, SCS, and discograms. I don't wear a mask for anything else.

If I ever get an infection after an ESI, SCS, disco, I don't want to give an attorney any ammunition. Same reason I don't use kenalog. Not a true clinical reason, just CYA.