Please submit clinical questions regarding implementation of the National Patient Safety Alert - Transition to NRFit connectors for intrathecal and epidural procedures, and delivery of regional blocks to SALG at the following email address: [email protected]
SALG position statement on availability of NRFit-compatible equipment for procedures covered by the NHS England alert
SALG’s position is that where NRFit-compatible equipment is unavailable, or if available options are not suitable clinically for procedures covered by the alert, non-NRFit options should be used until such a time as a suitable, NRFit compatible version does become available. In the meantime, we would strongly encourage anaesthetic departments to ensure that the non-availability of such equipment is placed on the risk register.
Are pain procedures covered by the NHS England alert?
Yes, pain procedures are covered by the alert. The Faculty of Pain Medicine has supported implementation of the alert- their position statement can be found on their website here.
Are NRFit -compatible paediatric caudal devices available?
The Association of Paediatric Anaesthetists of the United Kingdom and Ireland (APA) has written a letter to their members about the availability of these devices. This has been supported by SALG, and is available on the APA website here.
Is NR-Fit compliant equipment available for ophthalmic procedures?
Anaesthetists typically use 25G, 25 mm needles for retrobulbar and peribulbar blocks and specialist cannulas for sub-Tenon blocks. The volumes involved are quite small – typically around 10 ml. The subtenon technique is described here. https://eyewiki.org/Sub-Tenon_Anaesthesia and the cannulas listed here in NHS Supply Chain. https://my.supplychain.nhs.uk/catalogue/product/fsp11624.
As far as we are aware, none of the equipment that is used for such blocks is available in an NR-Fit compliant version. There are many complications associated with needle techniques for eye block (globe perforation, dural puncture, arterial trauma, intravenous injection) but none of these will be addressed by the change from Luer fit to NRFit. The lack of evidence of a patient safety benefit to adoption of NRFit in this area of practice means that there is no discernible appetite for moving ophthalmic anaesthesia over to NR-Fit- compliant equipment currently. It is unlikely therefore that manufacturers are going to prioritise producing NRFit compatible versions in the future, although of course we cannot rule this out.
We currently undertake regional blocks such as fascia iliaca blocks using a standard hypodermic needle. Can we continue to do this, or do we need to swap to using an NR-Fit-compatible spinal needle instead?
While it is possible to do a regional block such as fascia iliaca block with a standard hypodermic needle, using a regional block needle makes it easier to feel the tissue planes, visualise the needle shaft and tip on ultrasound, as well as having injection tubing to aid aspiration and injection. NRFit-compliant equipment is now available for regional blocks including fascia iliaca blocks from NHS Supply Chain. Please contact your procurement team who will be able to assist you in the transition from Luer to NRFit. From a safety point of view, we cannot advocate continued use of hypodermic needles with Luer connectors when there is a safer, more effective solution that is NR-Fit compliant. The fascia iliaca block uses a large volume of local anaesthetic, typically 30 to 40 ml of 0.25% bupivacaine, making it especially important to use NRFit-compliant equipment to avoid wrong route administration.