Regional anesthesia equipment checkout recommendations: a case report and discussion

The use of an apparatus checkout list is common in medicine and anesthesia. After being involved in a case in which the separation of a spinal introducer hub from its shaft during subarachnoid block required surgical removal of the retained shaft, a search for related cases was undertaken. The Medline database from 1966 to 1997 was used to identify defects and problems related to centroneuraxis equipment. Using these data, a regional anesthesia equipment checkout list of six recommendations was created in the spirit of other anesthesia checkout lists. The recommendations are to (1) ensure the proper fit and length between the needle and its stylet (particularly if using resterilized needles), (2) check for defects in the needle hub and shaft union by applying axial traction to the hub, (3) flush the needle with the distal end occluded, checking for defects in the hub-shaft junction or in the shaft itself, (4) check for malalignment between the needle hub and shaft, (5) examine the catheter for consistency in diameter and ensure the catheter can be introduced into the needle, and (6) flush the catheter, checking for the presence, patency, and location of distal holes. These recommendations must undergo further review before they are accepted as a practice standard.