Chloraprep

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smarterchild

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My practice recently switched from Betadine to using the individually packed chloraprep swabs for preprocedure skin preps. An interesting tidbit I read on the wrapper was that while the applicator is sterile the chg solution inside isn’t.

A brief search online led me to this from the manufacturer:


seems like chloraprep solution has never been sterile and not even available at the moment.

I was just curious for those of you using Chloraprep, are your solutions also non-sterile and is it acceptable to use this 3 ml sponge applicator as my sole pre-procedural skin prep?

thanks!
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longer dry time for betadine, Ive heard 10 minutes for surgery? Also chlorhexidine was shown to be superior in some ASRA thing for disinfectant from what I heard. I think many use the bottled solution and pour it in the tray since they don't put chlorhexidine in the spinal kits.
 
wait what? no one's waiting 10 minutes for anything to dry before a lumbar epidural. whats everyone using??
 
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Chloraprep for everything unless they've a history of a reaction, then I use Betadine.

Haven't had an issue yet.
 
Thanks for the input. Chlorapreps official recommendation is 30 seconds for non-hairy, dry areas and up to an hour of drying time for moist areas that have hair. For betadine, I usually waited around 5 minutes for it to dry.

chloraprep, last I checked, has been shown to be superior to betadine and it’s less messy. I was just thrown off by the “non sterile liquid” comment on the label.
 
I reached out to the local BD rep and his response was that they do not recommend chloraprep for spinal procedures. Reading through the fine print, it says Chloraprep should not be used for any lumbar punctures or procedures that contact the meninges. I have never heard that before. Do you all think its still safe to use it for our ESI, RFA, etc? I've used Duraprep for years for my SCS trials and never had an issue.
 
It had to do with chloraprep being inadvertently injected intrathecally in europe, they were putting it in the kits. Betadine works by lysing the cell walls via inophores I think, if your splashing your not waiting long enough
 
smarterchild said:
I reached out to the local BD rep and his response was that they do not recommend chloraprep for spinal procedures. Reading through the fine print, it says Chloraprep should not be used for any lumbar punctures or procedures that contact the meninges. I have never heard that before. Do you all think its still safe to use it for our ESI, RFA, etc? I've used Duraprep for years for my SCS trials and never had an issue.
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If you accidentally inject betadine or alcohol into the epidural space I think the results will be subpar.
 
The fire risk in the OR is 3 min per hospital policy where I do cases. I always prep the skin and while placing towels and drapes it is drying. I place Ioban and make sure there's no standing fluid so to speak and I think it's fine.

No such thing as a free lunch IMO.
 
Echo most of what has been said here. Chloroprep has been shown to be superior than betadine I believe, but they're both just fine. Chloroprep is more irritating to the meninges, so some people just use betadine for spinal procedures. Doesn't really matter practically speaking what you use, just make sure it's dry first.

Betadine and Chloroprep are allowed to dry both for fire hazard as well as it increasing the effectiveness. Chloroprep you need to scrub in (not just pain the surface), iodine we do the circle in-to-out thing.

Prep, then draw your meds. It'll be dry by time you're ready to poke.
 
SommeRiver said:
The fire risk in the OR is 3 min per hospital policy where I do cases. I always prep the skin and while placing towels and drapes it is drying. I place Ioban and make sure there's no standing fluid so to speak and I think it's fine.

No such thing as a free lunch IMO.
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against policy. Cannot drape until 3 min after prep.
 
Regarding all the information regarding chloraprep being superior- there was some definite conflict of interest between the makers of chloraprep and the researchers that recommended it. About it not being good for neuraxial, there was a case of someone injecting it intrathecally. That is why it is tinted and why it doesn't come in kits. So betadine may not be worse or take as long.... but I still use chloraprep for time saver. Also, it is supposed to leave 3x less bacteria, etc. The CHG must also have alcohol or it is no where as effective as routinely stated.
 
What do you for patients with allergy to betadine and chloroprene and chlorhexadine?
 
Chlorhexadine sellers can't recommend for spinal procedures because they don't have FDA clearance for that - just like fentanyl doesn't have clearance for epidural use. So the take home message? Completely ignore.

I don't think betadine has FDA approval for use in spinal procedures either - or is just as toxic to unprotected neural structures - but no one cares about that.

The use of CHG and neuraxial procedures was a thing several years ago - but now completely ignored as far as I can tell because many societies have come out claiming it is superior.
 
Betadine stains if it gets on clothes, especially if you bleach them with betadine on them. This is what my patients really care more about, so we use Chloraprep because it doesn’t stain. 😛
 
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