Statement on disruption to supply of Smiths Medical Epidural and Combined Epidural/Spinal products containing the Portex® Loss of Resistance (LoR) syringe

25 May 2022

The Royal College of Anaesthetists, Association of Anaesthetists, Obstetric Anaesthetists' Association and Regional Anaesthesia-UK have been informed of a disruption to supply of Smiths Medical Epidural and Combined Epidural/Spinal products containing the Portex® Loss of Resistance (LoR) syringe.

This is due to difficulty obtaining a dye required for the plastic of the loss of resistance syringe and has led to a temporary disruption in production and supply. The estimated recovery is the end of June or beginning of July 2022.

We have been informed that NHS Supply Chain (NHSSC) are now controlling supply of all epidural insertion kits. Hospitals will not be able to order directly from Smiths or from other distributors. Local procurement leads have been asked to continue to order their usual products from NHSSC; however, alternative brands and alternative kits (e.g. 18G rather than 16G) may be provided depending on supply/demand. Until this situation has stabilised, NHSSC will be providing approximately one week’s worth of stock to organisations on request. The NHS is undertaking a stocktake of current supplies in the system via local procurement teams.

The following clinical information is intended to support clinical colleagues in mitigating the impact of this disruption and to reduce wastage:

• Standard syringes can be used instead of LoR syringes if the latter are unavailable:
  • While most anaesthetists have been trained to use low-resistance syringes, significant numbers of anaesthetists use standard syringes as their preferred equipment for epidural techniques.
  • Where low-resistance syringes are available, but in short supply, their use should be prioritised towards less experienced practitioners, with senior and experienced anaesthetists adopting the use of ordinary syringes in the first instance.
  • Clinicians may wish to trial use of normal syringes on an epidural simulator.
• For procedures where epidural kits are used to facilitate tunnelling of a catheter, clinicians should consider either using a kit without a LoR syringe or using alternative catheters and tunnelling devices such as a large gauge venous cannula, thus preserving the syringe-containing kits for epidural use.
• As per normal practice shared decision-making principles should be used to decide on the most appropriate form of anaesthesia and/or analgesia for each patient, taking the current situation into consideration.
• As for any change in medical equipment, it will be essential good practice, and informative, to monitor and audit any complications during this period.