Chlorhexadine prep for peripheral nerve blocks?

[jd1572]

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What kind of prep do you use to sterilize the entry site of your peripheral nerve blocks (i.e., interscalene, femoral, etc.)? Betadine or chlorhexidine (chlora-prep)?

One person I worked with mentioned that there can be nerve damage if you use chlorhexidine. But, the only info I found on the chlorhexidine (chloraprep) website states that it should not be used for lumbar puncture or if there will be contact with the meninges.

Thanks!

 

[dfk]

What kind of prep do you use to sterilize the entry site of your peripheral nerve blocks (i.e., interscalene, femoral, etc.)? Betadine or chlorhexidine (chlora-prep)?

One person I worked with mentioned that there can be nerve damage if you use chlorhexidine. But, the only info I found on the chlorhexidine (chloraprep) website states that it should not be used for lumbar puncture or if there will be contact with the meninges.

Thanks!

huh, that's funny.
my current hospital OB unit, they're throwing this stuff on like hotcakes.

 

[Kubed]

huh, that's funny.
my current hospital OB unit, they're throwing this stuff on like hotcakes.

Ditto. I don't think i've ever seen a block where a catheter is left behind that didn't use it. ... granted I've got a pretty small N value for that.

 

[bubalus]

Chloraprep all the way. I use it for my epidurals and spinals too. There are a couple studies that show reduced epidural catheter colonization with chloraprep because you don't rinse it off and it maintains some killing action.

The warning about contact with meninges comes from the 1950s when scientists were evaluating various compounds for neurotoxicity by giving monkeys intrathecal injections of whatever they were testing. Chlorhexadine caused some neurotoxicity, hence the warning, but I think there's a huge difference between giving someone an intrathecal chlorhexadine injection and using it to prep the skin.

 

[lobelsteve]

Reduced infection risk when using Chlorhexidine over iodine. Alcohol is insufficient.

Chlorhexidine can cause corneal opacification- so don't splash it around too much. So rinse like crazy ASAP if it gets in your EYE. The procedure can wait 5 minutes, your eye cannot.

 

[militarymd]

i use it

 

[psychbender]

Chloraprep is all I've ever seen the regional guys use over here.

For epidurals, though, most others seem to just use the betadine that comes in the kits.

 

[Gator05]

FWIW, it's what ASRA recommends.

 

[BLADEMDA]

FWIW, it's what ASRA recommends.

The use of Chloraprep for peripheral nerve blocks is highly recommended. For Epidural anesthesia it is more controversial due to the fact that the manufacturer won't stand behind its safety profile for neuraxial anesthesia. Finally, spinal anesthesia would be the one type of block where caution may be advised as there is some theoretical risk of trace amounts of the substance entering the CSF.

Do I personally think the benefits outweigh the risks even with spinal anesthesia? Yes. But, I fully understand a practitioners reluctance to use this Prep for a single shot spinal anesthetic until more data or more studies are published regarding its safety.

Even the landmark study comparing Epidural catheter colonization rates with different Prep solutions NOTED that Chloraprep is controversial in Neuraxial Anesthesia.

Blade

 

[Gator05]

Chlorhexidine is not approved for neuraxial-anesthetic use in part because it wasn't tested for this. Yes, I understand the older studies directly injecting the stuff intrathecally = bad, and this is also a source of discontent for neuraxial use.

If you look closely, I don't ever recall seeing our iodine-related soaps being explicitly approved for neuraxial use either. Again, never explicitly tested.

 

[epidural man]

funny how people worry about this since betadine is probably every bit as neurotoxic to the spinal cord.

Chloroprep continues to work even up to 12 hrs after it is applied, maybe even longer. Betadine stops the moment it does its thing - 3 minutes mabye?

No contest really.