From the Guidelines
No, it is not standard of care to place an intravenous (IV) line for all outpatient epidural steroid injections. IV access is generally considered optional for routine, uncomplicated epidural steroid injections performed in an outpatient setting. The decision to place an IV should be based on patient-specific factors, procedural complexity, and facility protocols. Factors that might warrant IV placement include patients with significant medical comorbidities, history of adverse reactions to medications, anticipated need for moderate sedation, or high-risk procedures. When IV access is established, it typically uses a 20-22 gauge catheter placed in a peripheral vein. The primary purpose of IV access during these procedures is to provide a route for rapid administration of medications in case of adverse events such as vasovagal reactions, allergic reactions, or local anesthetic toxicity. Many experienced practitioners safely perform uncomplicated epidural injections without IV access, relying instead on careful patient selection, monitoring, and having emergency medications and equipment readily available. The risk of serious complications requiring IV medication during routine epidural steroid injections is very low, which supports the practice of selective rather than universal IV placement 1.
Some key points to consider:
- The risk of serious adverse events is low, with a total of 90 serious adverse events reported within minutes to 48 hours after epidural injections of corticosteroids for management of neck and back pain, including death, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, stroke, seizures, and brain oedema 1.
- The use of IV access should be based on individual patient needs and procedural complexity, rather than as a routine practice for all patients undergoing epidural steroid injections.
- Careful patient selection, monitoring, and having emergency medications and equipment readily available are essential components of safe practice, regardless of whether IV access is established 1.
Overall, the decision to place an IV line for outpatient epidural steroid injections should be made on a case-by-case basis, taking into account the individual patient's needs and the specific procedure being performed.
From the Research
Standard of Care for Outpatient Epidural Steroid Injections
- The provided studies do not directly address whether it is standard of care to place an IV for all outpatient epidural steroid injections 2, 3, 4.
- However, studies discuss the importance of safety considerations and best practices in administering epidural steroid injections 3 and the preparation and administration of intravenous medicines 5, 6.
- The study on the preparation and administration of intravenous medicines highlights the need for best practice standards to ensure patient safety, but does not specifically address the use of IVs in outpatient epidural steroid injections 5.
- The 2021 Infusion Therapy Standards of Practice Updates provide guidance on infusion therapy, but do not explicitly state whether an IV is required for all outpatient epidural steroid injections 6.
- Overall, there is no clear evidence to suggest that placing an IV is a standard of care for all outpatient epidural steroid injections, but safety considerations and best practices should be followed to minimize risks 3, 5, 6.