Luer‐lock epidural connections

The recent tragic death of a patient following intravenous rather than epidural administration of a local anaesthetic should serve to stimulate more interest in safety design. The undoubted benefit of epidural infusion analgesia for postoperative pain relief has significantly increased its popularity. We can therefore expect even such extremely rare tragedies to become more frequent. Indeed, we are aware of three cases of cross-connected epidural and intravenous central lines in the past five years in the South East alone – despite procedures and policies designed to minimise risk. Is it not time that we re-assessed the safety of having a common luer-lock connection for both intravenous and epidural drug administration? Perhaps the easiest design modification would be to reverse the current female port at the end of epidural and spinal catheters into a male ending. This would then physically prevent connection of a standard intravenous syringe to a spinal or epidural catheter. A specific ‘spinal syringe’ with a female connection would be required to enable epidural or spinal drug administration. A second stage in the development of this approach would be to re-design the epidural and spinal needles themselves with male ports, so that the initial epidural or spinal injection would again require a ‘spinal syringe’. The manufacturing technology is there to produce such ports – but do we as a profession dedicated to safety have the will to require a change? The profession has insisted on, and got, high standards of safety in anaesthetic machines and patient monitoring when the patient is asleep. Why not aim for similar safety when the patient is awake with an epidural or spinal?