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pain. Ten of the 12 patients had received codeine on the ward before discharge. Clear written instructions regarding codeine use accompanied the prescriptions. No adverse events were recorded either in the ward or at home. Although no patients were harmed over the study period, our audit confirmed ongoing prescription for patients in whom there was a risk of potential harm. Similarly to other organisations [2], codeine has now been removed from the list of medications that can be dispensed for home use, and is not routinely available on the ward, patients being given regular paracetamol for seven days and ibuprofen for three days to take home, instead. A follow-up audit is intended to assess analgesia in the light of these changes. K. W. Tan S. Martin G. Bell Royal Hospital for Sick Children, Glasgow, UK Email:
[email protected] No external funding and no competing interests declared. Previously posted on the Anaesthesia correspondence website: www.anaesthesiacorrespondence.com.
References 1. Medicines and Healthcare products Regulatory Agency. Codeine for analgesia: restricted use in children because of reports of morphine toxicity. Drug Safety Update. July, 2013. http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/ CON296400 (accessed 21/07/2014). 2. Palanisamy A, Bailey CR. Codeine in mothers and children: where are we now? Anaesthesia 2014; 69: 655–60. doi:10.1111/anae.12836
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Magnetic resonance imaging safety of Epilong Soft epidural catheters We would like to draw readers’ attention to a new epidural catheter containing an integral stainless steel spiral designed to resist buckling, which presents a potential safety risk should magnetic resonance imaging (MRI) be undertaken subsequently. Although both the external cover of the EpiLong Soft, 0431157-48, Pajunk Medizintechnologie GmBH, Geisingen, Germany) insertion pack and the equipment information sheet contain clear documentation that the product is not MRI compatible, once in situ, the catheter is indistinguishable from other coil-free catheters. In correspondence, Pajunk stated the following “Both the needle and the EpiLong Soft catheter do contain materials which are not compatible to MRI. Therefore, we do not advise (using either) the needle (or) catheter under MRI imaging. Use of these devices in (an) MRI environment can lead to several problems: 1 Problems of visualisation: The device may not be possible to identify under MRI. Its real position can vary from the shown position; 2 Problems of magnetically-induced displacement force and torque: The needle and the catheter contain materials which are magnetic; 3 Problems of heating: Due to radiofrequency during MRI, the device could be heated; 4 Induction of currents: The MRI could induce currents in the device.
Please be aware that additional risks can occur which are not named in this list.” This is of particular relevance should a patient require MRI investigation for potential epidural haematoma, in which premature catheter removal is discouraged for fear of further bleeding [1]. Under these circumstances, computed tomography may be a safer alternative if MRI compatibility of the indwelling epidural catheter is uncertain [2]. P. McCall M. Steven B. Shelley Golden Jubilee National Hospital, Clydebank, Scotland Email:
[email protected] No external funding and conflicts of interest declared.
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References 1. Cook TM, Payne S, Anns J. One year on from NAP3: dissemination and clinical changes after the Third National Audit Project of the Royal College of Anaesthetists. British Journal of Anaesthesia 2011; 107: 978–82. 2. Meikle J, Bird S, Nightingale JJ, White N. Detection and management of epidural haematomas related to anaesthesia in the UK: a national survey of current practice. British Journal of Anaesthesia 2008; 101: 400–4. doi:10.1111/anae.12842
Fractured intravenous cannula During general anaesthesia, leakage of intravenous crystalloid was observed under a dressing securing a 22-G Venflon Pro SafetyTM (Becton Dickinson UK, Swindon, UK).
© 2014 The Association of Anaesthetists of Great Britain and Ireland
