title: A clinical evaluation of four non-Luer spinal needle and syringe systems.
abstract: We performed an evaluation of non-Luer spinal devices supplied by four manufacturers or suppliers: Polymedic; Pajunk; Sarstedt; and Smiths. For each supplier, 100 evaluations were performed using a 25-G 90-mm spinal needle, 3-ml syringe, 5-ml syringe and filter needle; for comparison, 100 evaluations were performed with our standard Luer equipment. The non-Luer devices were associated with more qualitative problems compared with the Luer devices, for example, poor feel of dural puncture (9-32% vs 10%, respectively), poor observation of cerebrospinal fluid in the hub (3-27% vs 0%), and connection problem of the syringe to the spinal needle (7-33% vs 0%). There was also more frequent failure to achieve the spinal injection due to equipment-related causes (4-7% vs 0%, respectively). Median (IQR [range]) numeric satisfaction scores for the spinal needles were: Luer 10 (9-10 [7-10]); Polymedic 7 (4-8 [0-10]; Pajunk 7 (5-8 [0-10]); Sarstedt 7 (6-8 [0-10]); and Smiths 9 (7-10 [0-10]) (p<0.0001). Satisfaction scores for all spinal equipment were: Luer 10 (9-10 [5-10]); Polymedic 8 (6-8 [0-10]); Pajunk 7 (5-7 [1-9]); Sarstedt 8 (6-8 [0-10]); and Smiths 8 (8-9 [2-10]) (p<0.0001). Between 21% and 75% of non-Luer evaluations were rated with satisfaction worse than the usual Luer needle compared with 0-10% rated better, depending on the needle type. Between 22% and 76% of non-Luer evaluations were rated with satisfaction worse than the usual Luer equipment compared with 0-14% rated better. Specific concerns included poor feel of tissue planes and observation of cerebrospinal fluid (Polymedic), difficulty with connection of the syringe to the spinal needle and trocar removal (Pajunk), poor feel of tissue planes and needle flexibility (Sarstedt) and difficulty with connection of the syringe to the spinal needle (Smiths). We could not demonstrate a short-term learning curve for the new devices. Decisions on purchasing and implementation of the new non-Luer equipment will have to acknowledge that clinicians may have greater technical problems and reduced satisfaction compared with the current equipment.
authors.affiliation: St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. stephen.kinsella@uhbristol.nhs.uk
authors.forename: S M
authors.initials: SM
authors.lastname: Kinsella
authors.forename: A
authors.initials: A
authors.lastname: Goswami
authors.forename: C
authors.initials: C
authors.lastname: Laxton
authors.forename: L
authors.initials: L
authors.lastname: Kirkham
authors.forename: N
authors.initials: N
authors.lastname: Wharton
authors.forename: M
authors.initials: M
authors.lastname: Bowen
mesh_terms: D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D006801:Humans; D009339:Needles / Q000009:adverse effects; D061214:Patient Safety; D013129:Spinal Puncture; D013594:Syringes / Q000009:adverse effects; D017211:Treatment Failure