Is it safe to re-access sodium bicarbonate bottles for use in minor surgery?
jpedsurg.org shows its articles on its own site.
Read the article on jpedsurg.org ↗Article · Apr 2018 · 1 min read
In brief
In brief
Laboratory study demonstrates that common bacterial pathogens can survive in sodium bicarbonate vials for up to 7 days, supporting single-use protocols despite waste concerns. Authors recommend pharmacy repackaging into smaller vials or pre-alkalizing lidocaine as safer alternatives to vial re-access in minor surgical procedures.
Written by the GCMD Library team from the article.
Background/Purpose
Sodium bicarbonate is added to lidocaine to reduce injection pain. In Canada, it is available in vials exceeding the injection volume 100-fold. These are single-use vials that should be disposed of after one access. Some surgeons re-use vials to reduce waste, potentially causing contamination. This study aims to review the safety of sodium bicarbonate and assess alternatives to current practice.
Methods
Strains of Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Burkholderia cepacia were used to assess bacterial growth in vials of sodium bicarbonate. Each pathogen was inoculated into a vial for 14 days at room temperature. At several time points, 1 mL of solution was removed and diluted. One hundred microliters were transferred to blood agar plates and incubated at 35 °C. Colony counts were calculated, averaged and plotted onto a logarithmic graph.
Results
Colony counts of all strains fell below observational threshold after 7 days in sodium bicarbonate.
Conclusions
Although all strains were reduced, bacteria can survive in sodium bicarbonate for several days, during which transmission may occur. Sodium bicarbonate vials should be treated as single-dose, as indicated by the manufacturers. To reduce waste, hospital pharmacies can repackage sodium bicarbonate into smaller vials or pre-alkalize lidocaine with sodium bicarbonate.