Prevention, Diagnosis, and Management of Infectious Complications Associated with Neuraxial Techniques

Publication Date: April 1, 2017
Last Updated: March 14, 2022

Summary of Advisory Statements

Prevention of Infectious Complications Associated with Neuraxial Techniques

  • Before performing neuraxial techniques, conduct a history and physical examination relevant to the procedure and review relevant laboratory studies in order to identify patients who may be at risk of infectious complications.

  • Consider alternatives to neuraxial techniques for patients at high risk.

  • When neuraxial techniques are selected in a known or suspected bacteremic patient, consider administering preprocedure antibiotic therapy.

  • Select neuraxial technique on a case-by-case basis, including a consideration of the evolving medical status of the patient.

  • Avoid lumbar puncture in the patient with a known epidural abscess.

  • Use aseptic techniques during preparation of equipment (e.g., ultrasound) and the placement of neuraxial needles and catheters, including:

    • Removal of jewelry (e.g., rings and watches)

    • Hand washing

    • Wearing of caps

    • Wearing of masks covering both mouth and nose

      • Consider changing masks before each new case.
    • Use of sterile gloves

    • Sterile draping of the patient

  • Use individual packets of antiseptics for skin preparation.

  • Use an antiseptic solution (e.g., chlorhexidine with alcohol) for skin preparation, allowing for adequate drying time.

  • Use sterile occlusive dressings at the catheter insertion site.

  • Bacterial filters may be considered during extended continuous epidural infusion.

  • Limit the disconnection and reconnection of neuraxial delivery systems in order to minimize the risk of infectious complications.

  • Consider removing unwitnessed accidentally disconnected catheters.

  • Catheters should not remain in situ longer than clinically necessary.


Overview

Title

Prevention, Diagnosis, and Management of Infectious Complications Associated with Neuraxial Techniques

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