Orthopaedic Surgery, Stanford Hospital, Stanford, California.
Orthopaedic Surgery, Stanford Hospital, Stanford, California; Palo Alto VA Hospital, Palo Alto, California.
J Arthroplasty. 2018 Mar;33(3):844-846. doi: 10.1016/j.arth.2017.10.028. Epub 2017 Nov 11.
Multiple antiseptics have been described for use in total joint arthroplasty infection, and the use of multiple antiseptic solutions during a single operation has been described. Our clinical experience is that chlorhexidine (CHX) and Dakin's solution (NaOCl) interact and form a precipitate. The purpose of this study is to determine whether this reaction could be replicated in a laboratory setting, and to determine if other commonly used antiseptics also visibly react when mixed.
Four percent chlorhexidine gluconate (CHX), 0.5% sodium hypochlorite (NaOCl), 3% hydrogen peroxide (HO), and 10% povidone-iodine (BTD) solutions were obtained and all possible combinations were mixed. Any visible reactions were noted and recorded, and a literature search was performed to characterize the reaction and products.
CHX and NaOCl, CHX and HO, and CHX and BTD reacted instantly, forming a precipitate. NaOCl and HO reacted to produce a gas. NaOCl and BTD reacted and produced a color change. The literature review revealed that at least 2 of the reactions tested (CHX + NaOCl and NaOCl + HO) could result in byproducts toxic to humans.
Surgeons must be aware of these interactions when using antiseptic solutions during procedures. Caution should be used combining or mixing antiseptics, and we recommend against concomitant introduction in a surgical wound.
已有多种防腐剂被用于全关节置换感染，且在单次手术中使用多种防腐剂的方法已有描述。我们的临床经验是洗必泰（CHX）和 Dakin 溶液（次氯酸钠）会相互作用并形成沉淀。本研究旨在确定这种反应是否可以在实验室环境中重现，并确定其他常用防腐剂在混合时是否也会发生可见反应。
获得了 4%葡萄糖酸氯己定（CHX）、0.5%次氯酸钠（NaOCl）、3%过氧化氢（HO）和 10%聚维酮碘（BTD）溶液，并混合了所有可能的组合。记录任何可见的反应，并进行文献检索以表征反应和产物。
CHX 和 NaOCl、CHX 和 HO，以及 CHX 和 BTD 立即反应，形成沉淀。NaOCl 和 HO 反应产生气体。NaOCl 和 BTD 反应并产生颜色变化。文献回顾表明，至少有 2 种测试的反应（CHX + NaOCl 和 NaOCl + HO）可能会产生对人体有毒的副产物。
外科医生在手术过程中使用防腐剂溶液时必须意识到这些相互作用。在混合或混合防腐剂时应谨慎，并建议避免同时引入手术伤口。
