Last updated March 15, 2022

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

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.


Diagnosis of Infectious Complications Associated with Neuraxial Techniques

  • Perform daily evaluation of patients with indwelling catheters for early signs and symptoms (e.g., fever, backache, headache, erythema, and tenderness at the insertion site) of infectious complications throughout their stay in the facility.

  • To minimize the impact of an infectious complication, promptly attend to signs or symptoms.

  • If an infection is suspected:

    • Remove an in situ catheter and consider culturing the catheter tip.

    • Order appropriate blood tests.

    • Obtain appropriate cultures.

    • If an abscess is suspected or neurologic dysfunction is present, perform imaging studies and promptly obtain consultation with other appropriate specialties.


Management of Infectious Complications

  • Administer appropriate antibiotic therapy at the earliest sign or symptom of a serious neuraxial infection.

  • Consider consultation with a physician with expertise in the diagnosis and treatment of infectious diseases.

  • If an abscess is present, obtain surgical consultation to determine whether percutaneous drainage of the abscess or surgery (e.g., laminectomy) is warranted.


Recommendation Grading

Overview

Title

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

Authoring Organization

Publication Month/Year

April 1, 2017

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Reduce the risk of infectious complications associated with neuraxial techniques by identifying or describing: patients who are at increased risk of infectious complications, techniques for reducing infectious risk, and interventions to improve outcomes after infectious complications.
 

Target Patient Population

Patients receiving neuraxial techniques

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse anesthetist, nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Prevention, Management

Diseases/Conditions (MeSH)

D013126 - Spinal Nerve Roots

Keywords

neuraxial infections, nerve blocks, bursal infections

Source Citation

Practice Advisory for the Prevention, Diagnosis, and Management of Infectious Complications Associated with Neuraxial Techniques: An Updated Report by the American Society of Anesthesiologists Task Force on Infectious Complications Associated with Neuraxial Techniques and the American Society of Regional Anesthesia and Pain Medicine*. Anesthesiology 2017;126(4):585-601. doi: https://doi.org/10.1097/ALN.0000000000001521.
 

Methodology

Number of Source Documents
174
Literature Search Start Date
January 1, 2010
Literature Search End Date
March 31, 2016