This is a joint statement from the Royal College of Anaesthetists, Association of Anaesthetists and Safe Anaesthesia Liaison Group on transition to non-Luer (NRFit) devices for neuraxial and regional block equipment
Transition to non-Luer (NRFit) devices for neuraxial and regional block equipment.
The requirement for the NHS to transition to the use of non-Luer connectors for neuraxial applications (spinal needles, epidural needles, catheters, and administration sets and other intrathecal devices) and for regional anaesthetic equipment (needles and administration sets) is well recognised across the UK. The original NHS England alert (1) was issued in 2011, and the latest alert Resources to support transition from the Luer connector to NRFit for intrathecal and epidural procedures, and delivery of regional blocks was published by NHS Improvement in August 2017(2). Wales, Scotland, and Northern Ireland have issued similar communications.
The ability for organisations to transition has been delayed for a variety of reasons including ongoing challenges in procuring the necessary items of equipment, most commonly relating to epidural procedures. The Covid pandemic has undoubtedly shifted focus from completing this transition and may have interrupted plans in some units. Despite these challenges, we are aware that some units have achieved 100% conversion to NRFit. In Wales, the Welsh Government has determined that the range and quality of NRFit compatible devices available is sufficient for Welsh healthcare organisations to start deploying NRFit compatible devices, and it is expected that most Welsh NHS organisations will have completed the changeover by the end of 2022. Some hospitals have already completed the transition to NRFit for both spinals and epidurals.
Recent supply issues from some of the established manufacturers have probably made NHS organisations cautious about NRFit deployment. This reduction in demand may subsequently have reduced the impetus for manufacturers to increase production. Nevertheless, supply problems are often temporary, NHS Supply Chain work with manufacturers to understand supply problems, and these should not distract UK healthcare organisations from planning a full transition to NRFit.
We anticipate NHS England will issue a National Patient Safety Alert to mandate final and full transition to NRFit in due course, with an anticipatory target within the next twelve months. As per previous alerts with this issue, we understand that this alert will be considered by each of the devolved administrations for their adoption of a similar approach and communication in their region.
We encourage all UK organisations to reinvigorate trust-wide working groups to develop an action plan to transition fully to NRFit as safely as possible, in anticipation of the alert being published. An FAQ guide from the Welsh group(3) is available which contains useful guidance. We encourage local clinicians and organisations to liaise closely with their suppliers and make their individual requirements very clear; this will help manufacturers understand demand and plan accordingly. Some of the key manufacturers (especially in the epidural domain) are asking their customers to tell them anticipated volumes and which product lines are required before deployment, to ensure they can meet the demand.
Organisations should expect the requirement to transition to NRFit to be reflected in the future criteria of the Royal College of Anaesthetists’ Guidelines for the Provision of Anaesthetic Services(4) and ACSA standards(5) and in the future guidelines of the Association of Anaesthetists.
1. Patient Safety Alert. ‘Safer spinal (intrathecal), epidural and regional devices. National Patient Safety Agency. January 2011
2. Patient Safety Alert. ‘Resources to support safe transition from the Luer connector to NRFit™ for intrathecal and epidural procedures, and delivery of regional blocks’ NHS Improvement August 2017.
3. Surgical Materials Testing Lab, Wales. FAQ for NHS Wales Neuraxial (ISO 80369-6/NRFit) connectors changeover. August 2021
4. Royal College of Anaesthetists. Guidelines for the provision of anaesthetic services.
5. Royal College of Anaesthetists. The ACSA standards.
Full document can be downloaded by clicking the SALG logo below