Using sterile water as diluent

[Quito]

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We ran out of sterile normal saline, and it's on backorder. Is there a way to use sterile water for the injectate by making it isotonic?

 

[lobelsteve]

Or just inject it.
Or mix it with 1% lido.

 

[Quito]

You're saying sterile water could be injected together with, for example, dexamethasone for a TFESI?

 

[lobelsteve]

You're saying sterile water could be injected together with, for example, dexamethasone for a TFESI?

Inadvertent sterile water injection in the epidural space: history revisited - PMC

www.ncbi.nlm.nih.gov

Don't inject it by itself. And don't be a resident accidentally injecting it as a 2cc bolus in Ob.

 

[Quito]

Is there a particular formula for mixing the sterile water with dex to make the mix isotonic, or does the mix not have to be isotonic?

 

[RoloTomassi]

Just use lido.

 

[lobelsteve]

Is there a particular formula for mixing the sterile water with dex to make the mix isotonic, or does the mix not have to be isotonic?

It has not been studied in TFESI that I can find. Recommend mixing it 50/50 with lido and try. If pain: Inject lido.

 

[bedrock]

Lido won’t help with CESI. I refuse to consider adding lidocaine to CESI.

 

[runfastnow]

Any one use extra contrast to mix with steroid or injectate?

When we've run out of saline or want to use extra volume have used 0.3-0.5 mL (or whatever amount you desire) of left over contrast as a "chaser" to ensure no injectate left in tubing or needle.

 

[Ferrismonk]

I don't think I'd use sterile water as a carrier. My group has been using sterile saline flushes if needed. You could always just use contrast or go low volume if you are local adverse.

 

[Quito]

Great ideas! Thanks everyone!

 

[Dr. Ice]

Saline flushes

 

[MitchLevi]

Contrast

 

[Multimodal]

I just inject the steroid and flush it through with a little bit of air until the fluid clears the translucent hub of my needle but not enough that Im just inflating the epidural space. had to do this for a few weeks when we went through a saline shortage a few weeks ago. I havent noticed a change in those patients vs those who received diluted steroid.

 

[Orin]

Second the saline flushes, the vials are backordered but the preservative free flushes are available

 

[painfree23]

Remember with the sterile saline syringes the syringes themselves aren’t usually sterile