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[Electron microscopic analysis of particles from surgical gloves and their possible introduction into the epidural
M A Reina1, A López García, J L Aguilar
1Servicio de Anestesiología, Hospital General de Móstoles, Madrid.
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.
Material And Method:
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.
Insights
Surgical glove particles can contaminate epidural catheters, potentially causing inflammation. Avoid touching the catheter during epidural anesthesia to minimize particle transfer and reduce risks.
Area of Science:
- Anesthesiology
- Materials Science
- Medical Device Contamination
Background:
- Surgical glove powder is linked to inflammatory reactions in various body cavities.
- Contamination during procedures like spinal and epidural anesthesia may lead to complications.
Purpose of the Study:
- To characterize microscopic particles on surgical gloves.
- To assess the likelihood of these particles entering the epidural space during catheterization.
Main Methods:
- Examined 100 epidural catheters (two types) using scanning electron microscopy.
- Simulated epidural anesthesia by touching catheters with gloves.
- Analyzed particles on glove and catheter surfaces using X-ray diffraction.
Main Results:
- External glove surfaces had calcium carbonate particles (3-4 μm).
- Internal surfaces showed larger, smooth particles with magnesium (11-14 μm).
- Catheters touched by gloves showed significant particle adherence compared to untouched ones (p < 0.001).
Conclusions:
- Particles from gloves can transfer to epidural catheters.
- Minimizing catheter manipulation is crucial to prevent particle introduction.
- Avoiding touch of the insertion portion of the catheter can prevent inflammatory responses.