Epidural injections and infusions

This Patient Safety Alert sets out actions for all healthcare organisations in England and Wales to minimise risk when administering epidural injections and infusions.

Between 2000 and 2004, three patient deaths were reported following the administration of epidural bupivacaine infusions by the intravenous route.

A review of reports made to the National Reporting and Learning Service (NRLS) between 1 January 2005 and 31 May 2006, reveals that there were 346 incidents reported that involved epidural injections and infusions.

Most of these resulted in no or low harm, and included six incidents where epidural medicines had been administered by the intravenous route. The others included wrong route errors where intravenous medicines had been administered by the epidural route, and the wrong product selected resulting in the wrong drug or dose being administered.

The NRLS recommends all healthcare organisations in England and Wales take steps to minimise risk when administering epidural injections and infusions, including:

• Labelling infusion bags and syringes. 
• Minimising the likelihood of confusion between different types and strengths.
• Reducing the risk of the wrong medicine being selected.
• Using clearly labelled epidural administration sets and catheters that distinguish them from those used for intravenous and other routes.
• Using infusion pumps and syringe driver devices for epidural infusions that are easily distinguishable from those used for intravenous and other types of infusion. 
• Ensuring all staff involved in epidural therapy are adequately trained.