Safer neuraxial connectors - frequently asked questions

Q: The NPSA is about to disappear, do we still have to implement the Alerts?
A: Yes. Even though the NPSA is being subsumed into other bodies, NHS Hospitals in England and Wales are still bound to follow its Alerts.
   
Q: What’s happening with independent testing?
A:

Testing in Wales was part of a procurement exercise.  As no manufacturer could provide the whole range of equipment specified in the procurement document, the testing process did not take place.  The Department of Health in England has confirmed that no public monies are available for such testing.  Manufacturers have declined to fund any testing.

Testing has taken place in Bristol and Leicester.  It is hoped results from these will be available and published soon.
   
Q: My department has already chosen its preferred product, should we still proceed?
A: If you are happy that the products you have chosen are clinically effective and safe, the NHS encourages you to proceed.  Please ensure post-implementation vigilance and report any technical or other difficulties through local risk management processes and to the MHRA
   
Q: My department wishes to wait for independent testing, what should we do?
A: You should continue to use standard Luer devices, but must ensure their use is included in the hospital risk register, and must take all other steps to minimize the risk of error, for example consider the use of double-checking, or ‘stop before you inject’.  You must keep this “risk” under review, and reevaluate in the light of further testing results.
   
Q: What do we put on the risk register?
A: You should document that your hospital has not complied with the NPSA Alert and have decided to continue using standard Luer devices until the results of device testing are available to guide your choice of non-Luer connector.  The register should be reviewed regularly and steps taken to meet the NPSA Alert when feasible.
   
Q: What about Part B of the alert?
A: Part B (affecting epidurals and regional anaesthesia) takes effect from 1 April 2013.  The same risk management principles apply to Part B.  Hospitals may wish to consider combining Parts A and B, as further equipment and information become available.  This will avoid the risk of multiple connectors being in the clinical area.
   
Q: What about paediatrics?
A: Short non-Luer spinal needles and epidural needles will be available from some manufacturers for paediatric practice, and a prototype kit for single shot caudal injections is available from at least one manufacturer.

However it is likely that intravenous devices may continue to need to be used for caudal injections in children.  This use should be included in the risk register.
   
Q: My department is under pressure to introduce devices without waiting for testing?
A: The Advice from the Chair of the NPSA External Reference Group, and the Specialty Organisations has been consistent; clinicians must not be forced to use devices, which they genuinely believe present greater risk than those currently in use.

The most recent information can be found on the following websites: