What is the proper method for maintaining sterile technique during the administration of local anesthetic?

From the Guidelines

To maintain sterile technique during the administration of local anesthetic, it is essential to follow a meticulous preparation and execution protocol, including thorough handwashing, use of barrier precautions, and proper skin antisepsis with chlorhexidine in alcohol, as recommended by the most recent guidelines 1. When performing local anesthetic injections, the following steps should be taken:

• Thoroughly wash hands with antimicrobial soap and water for at least 20 seconds, then don sterile gloves.
• Prepare the injection site by cleaning with an antiseptic solution, such as 0.5% chlorhexidine in alcohol, starting at the center and moving outward in a circular motion, as this concentration is preferred due to its reduced neurotoxicity compared to 2% solutions 1.
• Allow the antiseptic to dry completely (about 30 seconds) to maximize its antimicrobial effect.
• Use only sterile, single-use vials of anesthetic and draw the medication using a new sterile needle and syringe.
• When administering the injection, maintain the sterility of the needle by not touching any non-sterile surfaces.
• After use, immediately dispose of needles and syringes in appropriate sharps containers to prevent needlestick injuries. These precautions are crucial in preventing infection, as local tissue trauma from needle insertion creates a potential entry point for pathogens, while the anesthetic itself temporarily reduces local blood flow that normally helps fight infection, as noted in earlier guidelines 1. Proper sterile technique minimizes the risk of introducing bacteria that could lead to abscess formation, cellulitis, or more serious systemic infections.

From the FDA Drug Label

The safety and effectiveness of local anesthetics depend on proper dosage, correct technique, adequate precautions, and readiness for emergencies. Injections should be made slowly, with frequent aspirations before and during the injection to avoid intravascular injection. Syringe aspirations should also be performed before and during each supplemental injection in continuous (intermittent) catheter techniques An intravascular injection is still possible even if aspirations for blood are negative.

The proper method for maintaining sterile technique during the administration of local anesthetic includes:

• Using proper dosage and correct technique
• Making slow injections with frequent aspirations before and during the injection
• Performing syringe aspirations before and during each supplemental injection in continuous catheter techniques
• Being aware that intravascular injection is still possible even if aspirations for blood are negative 2, 3

From the Research

Maintaining Sterile Technique

To maintain sterile technique during the administration of local anesthetic, the following steps should be taken:

• Use sterile technique to don sterile gowns and gloves, as outlined in the AORN "Recommended practices for sterile technique" 4
• Establish and monitor a sterile field, and correct any breaks in sterile technique immediately unless the actions necessary would endanger the patient 4
• Use surgical attire and personal protective equipment, and select and evaluate surgical gowns, gloves, and drape products appropriately for each procedure 4
• Limit movement and use techniques to ensure that items such as surgical instruments that may be contaminated are not used 5

Preparing the Sterile Field

Before preparing the sterile field, perioperative nurses should:

• Review the AORN "Guideline for sterile technique" and apply the recommendations when practicing sterile technique 5
• Take actions to reduce potential contaminants in the OR and maintain a sterile field during operative or other invasive procedures 5

Administering Local Anesthetic

When administering local anesthetic, it is essential to:

• Use aseptic technique to prevent contamination of the anesthetic solution and the injection site
• Note that there is no clinical advantage to using a 50/50 mixture of plain lidocaine and plain bupivacaine in place of their independent use, with respect to onset and duration of local blockade 6
• Be aware of the antimicrobial activity of local anaesthetics, and consider local disinfection prior to injection, especially in immunocompromised patients 7