[Electron microscopic analysis of particles from surgical gloves and their possible introduction into the epidural space during epidural anesthesia].
OBJECTIVE
Many publications have linked surgical glove powder to inflammatory reactions of the peritoneum, pleura, pericardium and meninges. Accidental contamination may also increase the likelihood of complications after spinal and epidural anesthesia. We aimed to analyze the morphological characteristics of microscopic particles adhering to surgical gloves and to analyze how likely such particles are to enter the epidural space during catheterization.


METHODS
One hundred epidural catheters were studied in two groups (A and B) of 50. Group A catheters contained stylettes and the distal ends were open (Vygon). Group B catheters contained no stylettes and had closed distal ends and three side openings (Becton Dickinson). Continuous epidural anesthesia was simulated with half the catheters in each group (25) by touching the distal end of each line with the gloves and later inserting the catheter through a Tuohy needle. All catheters--those used in the simulation as well as the untouched ones--were then examined under a scanning electron microscope. The particles on the internal and external surfaces of the gloves had previously been identified under a microscope and analyzed by X-ray diffraction.


RESULTS
Gloves: external glove surfaces carried particles measuring between 3 and 4 mu; their morphology was consistent with calcium carbonate. On internal surfaces we found larger particles, between 11 and 14 mu in diameter, shaped differently and of smooth appearance. Analysis of the latter showed them to contain traces of magnesium and to have characteristics consistent with organic molecules. The particles of one surface were never observed on the other. Catheters: the non-manipulated catheters in both groups contained no free particles matching those described above, whereas the outside surfaces of the catheters in contact with gloves contained particles consistent with those of external glove surfaces. The number of particles per square millimeter of surface was 2,598 (95% CI 2,200 to 2,900) in group A catheters and 2,340 (95% CI 2,000 to 2,600) in the group B catheters (p = NS). The differences in the number of particles adhering to catheters touched by gloves and those that had not been manipulated were statistically significant (p < 0.001).


CONCLUSIONS
Particles adhering to gloves can be drawn into the epidural space during continuous epidural anesthesia. All unnecessary manipulation should therefore be avoided, and the portion of the catheter to be inserted into the epidural space should not be touched in order to prevent possible nonspecific meningeal inflammatory responses.
Reina
M A
MA
Servicio de Anestesiología, Hospital General de Móstoles, Madrid.
López García
A
A
Aguilar
J L
JL
Palacios Martín
R
R
D000767:Anesthesia, Epidural / Q000295:instrumentation*; D002119:Calcium Carbonate / Q000032:analysis; D002404:Catheterization / Q000295:instrumentation; D004391:Dust / Q000009:adverse effects; D004824:Epidural Space; D004866:Equipment Contamination / Q000517:prevention & control; D005932:Gloves, Surgical; D006801:Humans; D008274:Magnesium / Q000032:analysis; D008855:Microscopy, Electron, Scanning; D010316:Particle Size; D011208:Powders
D004391:Dust; D011208:Powders; D002119:Calcium Carbonate; D008274:Magnesium