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Infection and spinal lines

1. True.  It has activity against a range of bacteria and fungi.

2. False.  Since you are using bacterial filters and bupivacaine is antimicrobial, the injected solution is the least likely route of entry for infection.  Because spinal analgesia involves infusing drugs close to, or into the intrathecal space, there is an understandable fear of meningitis with intrathecals, and epidural abscess with epidural lines.  With intrathecal lines the infection rate is less than 5% and deaths from meningitis are rare.

3. False.  The exit site is much more of a risk as the bacteria can travel along the spinal line tract.  Since the line is inert, it should produce no skin reaction - therefore any redness is an indication of local infection and would be an indication for antibiotics in the presence of pyrexia.  The exit site should be checked regularly (at least weekly) and sprayed with povidone iodone powder.

4. False. Serious intraspinal infection is unusual, even when the patient has an existing source of infection.  There is a higher risk in severely immunocompromised such as AIDS patients in whom a spinal line would pose a higher risk.

5. True.  The filters are guaranteed by the manufacturers for only a few days, but research has shown they are still active after a month.  Since the bupivacaine is antimicrobial and regular line disconnections increase the risk of infection, the distal filters are changed weekly and the filter nearest to the exit site is changed monthly.

6. True.  Pyrexia in a patient with a spinal line is usually caused by sources such as chest or urine (so a urine test would be useful). With intrathecal lines, a CSF sample would be withdrawn (without a filter) for culture.

©  2004 Radcliffe Publishing