#35908 Cerebrospinal fluid lavage for inadvertent intrathecal inyections. An option to be considered

Abstract

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Background and Aims

Intrathecal administration of wrong drugs (IAWD) can have catastrophic consequences. Reported IAWD in literature are mainly individual cases or small case-series reports. In most of them cerebral spinal fluid lavage (CSFL) seems to be a choice of management, added to support measures. The aim of this work is to know if CSFL could be considered as a safe and effective treatment in case of IAWD.

Methods

The author searched published reports of IAWD using Pubmed database from January 2017 to January 2023. Those in which CSFL was used as a treatment were selected. The main study founded was a review article that identifyed potential sources of IAWD and its appropriate management. Other studies described individual cases of IAWD managed with CSFL.

Results

Immediate CSFL is related to good outcomes in many of the studies reviewed. It involves CSF aspiration with a spinal catheter or a needle at the volume of 10–20 ml each time and replaced with an equal volume of normal saline, so the drug is diluted and removed. It´s usually make in emergency situations so it´s difficult to perform a propper randomized clinical trial evaluation. Maybe that’s why it is not considered as a standard treatment for IAWD.

Conclusions

Despite of the lack of studies published, early CSFL should be considered, in addition to supportive and symptomatic treatment, especially if life- threatening consecuences are anticipated. It is needed to balance the risks and benefits case-by-case before using CSFL, but does not seem to have major complications in an emergency situation.