From the Research
Saline for irrigation should not be used for injection into the common bile duct because it lacks the sterility and quality control standards required for internal injections. Irrigation solutions are manufactured for external use only and may contain contaminants, endotoxins, or particulate matter that could cause serious complications if introduced into the biliary system. For common bile duct injections, only solutions specifically labeled as "for injection" should be used, such as sterile 0.9% sodium chloride injection USP. These injection-grade solutions undergo rigorous testing for pyrogens, particulates, and sterility to ensure they're safe for internal use. Using irrigation solutions in the bile duct could potentially cause cholangitis, pancreatitis, or systemic infection. The distinction between irrigation and injection solutions is critical for patient safety, as they are manufactured under different quality standards despite having similar chemical compositions.
Some studies have shown the benefits of saline irrigation in reducing residual common bile duct stones after endoscopic removal, such as the study by 1 and 2, which demonstrated a significant reduction in residual stones with saline irrigation. However, these studies do not support the use of irrigation saline for injection into the common bile duct, but rather highlight the importance of using sterile solutions for internal use.
The most recent and highest quality study, 3, also emphasizes the importance of proper clearance of residual stones, but does not address the use of irrigation saline for injection. Therefore, based on the available evidence, it is recommended to use only sterile solutions specifically labeled for injection, such as sterile 0.9% sodium chloride injection USP, for injections into the common bile duct.
Key points to consider:
- Irrigation solutions are not suitable for internal injections due to lack of sterility and quality control standards
- Sterile solutions specifically labeled for injection should be used for common bile duct injections
- Using irrigation solutions in the bile duct can cause serious complications, such as cholangitis, pancreatitis, or systemic infection
- The distinction between irrigation and injection solutions is critical for patient safety.