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To Aspirate or Not

Discussion in 'General Issues and Discussion Forum' started by Zac, Jul 16, 2012.

  1. Zac

    Zac Active Member


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    When performing even a digital block, I was taught to aspirate prior to injecting local anaesthetic. Talking to a young colleague recently out of Uni, they are now told not to aspirate for digital blocks. What is the current accepted recommendation?
     
  2. Heather J Bassett

    Heather J Bassett Well-Known Member

    HI Zac I have noticed a change in teaching techniques as well. If the needle is not kept in one position then aspiration is not needed? I am attending a surgical conference and completing surgery on cadavers so looking forward to seeing if I can learn anything new! :)

    Cheers
     
  3. Here's fun. We have a few thousand years of podiatric experience on tap here. Has anyone ever aspirated in a toe and found that they WERE in a vessel?

    Personally I'm not sure it can be done!
     
  4. David Smith

    David Smith Well-Known Member

    To aspirate or not?

    Why not?

    Patient had Toxic reaction - did you aspirate? - no, never do - oh really, why not?:butcher:

    Dave
     
  5. Zac

    Zac Active Member

    I aspirate prior to injecting L.A. Generally the fluid coming into the needle is clear (& that is where I will inject the L.A.) [I should have said there is no fluid when aspirating] but occasionally, it will be blood, I withdraw or advance the needle & repeat.
     
    Last edited: Jul 16, 2012
  6. MJJ

    MJJ Active Member

    I did, twice on one toe. I felt like I should become a dowser after that.
     
  7. I stand corrected.

    I've obviously been very lucky!
     
  8. blinda

    blinda MVP

    Yeah, real lucky. You wouldnt want to experience having LA injected into a blood vessel... ;)

    BTW, I realised where you got your signature from last night. Went to see Hitchhikers live radio show last night. Superb start with this, then this. :cool:
     
  9. horseman

    horseman Active Member

    Loved Hitchikers when first on the radio, had to laugh quietly as it was on so late...:D

    Aspiration, I too was taught to always do this and since I use self aspirating syringes I can't very well stop, nor can I think of a good reason to do so.
     
  10. That was the tibial artery!! I defy anyone to dump enough in a digital vessel to make a difference.

    I'm clenching just from the memory :empathy:
     
  11. DTT

    DTT Well-Known Member

    Self Aspirating Syringes =
    The way to go :cool:
    Cheers
    D;)
     
  12. Peter1234

    Peter1234 Active Member

    Hi all,

    i dont understand the problem.... and the simple reason is that I have always used the dental syringes that are sold on podiatry sites, and they simply arent aspiratible!!! there is no way you can pull back the syringe and draw fluid back in. The scandonest mepivacaine vial has a rubber plug that only moves one way...toward the needle itself..

    the second point is...when you are in an artery for example in the tibial vessel at the ankle and you are injecting (not a good place to be) there will be no back pressure ...ie you will feel it....

    when you inject into the tissue there is always pressure against the fluid going into the body - and you know your not in the artery or vein

    have i missed something with this discussion, because i am thoroughly confused !!!
     
  13. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    We teach them NOT to aspirate for a digital block.
     
  14. DTT

    DTT Well-Known Member

    Peter having in my former life seen MANY arterial bleeds I promise if you are in a tibial artery you WILL get a backflow of blood :eek:
    Try removing the needle quickly and then pay for the repair of the blood stains on the wall or celing !!
    Digital blocks .....IMHO that aint gonna happen the arteries are not big enough to cause a problemo but move up to the bigger guys and yes you WILL know
    Cheers
    D;)
     
  15. DTT

    DTT Well-Known Member

    WHY ??

    Cheers
    D;)
     
  16. I agree, but since these are largely targeted at the dental profession, where do you get suitable self-aspirating cartridges that don't contain epinephrine or other vaso-constrictors?
     
  17. DTT

    DTT Well-Known Member

    Hi Si

    All ( or mostly all) of the regular podiatry suppliers have Scandonest ( NOT Scandodent with adrenaline) in 2.2 ml 3% cartridges which will fit the ultra safety plus and similar dental syringes.
    Hope that helps
    Cheers
    D;)
     
  18. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    The digital blood vessels are smaller than the needle.
     
  19. Peter1234

    Peter1234 Active Member

    to DTT : so i must have been very careful then as i have given hundreds of post tib blocks... it hasnt happened yet -touch wood..the one time i got a few drops of blood in the cartridge, the cartridge stopped working- is there something they arent telling us about the needle or the cartridge?
     
  20. Forgive my ignorance, but the cartridges I'm using are probably self-aspirting then, so what's the difference in the design of self-aspirating cartridge versus a non-self aspirating cartridge? Or, does it simply come down to the syringe itself?
     
  21. DTT

    DTT Well-Known Member

    27 g needle ?
    Cheers
    D;)
     
  22. Peter1234

    Peter1234 Active Member

    my guess is that its something to do with the needle, the blood didnt even get to the rubber 'plug' at the back of the cartridge
     
  23. DTT

    DTT Well-Known Member

    i
    Wots "probably "mean ??

    How do I know what your using ??

    JEEEEEEZ gimme a break :D:D

    cheers
    D;)
     
  24. Peter1234

    Peter1234 Active Member

    27g here
     
  25. DTT

    DTT Well-Known Member

    Its not supposed to.
    Just into the chamber at the other end of the sryinge just above where the needle connects.
    Cheers
    D;)
     
  26. You avoided the question: what's the difference between a self-aspirating cartridge versus a non-self aspirating cartridge.

    "I don't know" should suffice.;)
     
  27. DTT

    DTT Well-Known Member

    Can I just take this opportunity to thank the educators at Glasgow Caladonian University and the clinical assessors at Southern General Hospital for the successful completion of the course in local anaesthetics and nail surgery I recently underwent. ( there Joe Bean now you know, :cool:)

    An update in the latest anaesthetics,delivery systems and surgical techniques in this subject is never wasted = painless nail surgery:drinks

    That course was a great experience and is 100% recommended if it comes up again in the future for anyone interested.
    Cheers
    Derek;)
     
  28. DTT

    DTT Well-Known Member

    Si

    Yeah right:D

    The release of the plunger on the modern self aspirating sryinge cartridge uses a back pressure and draws a flash of blood into the chamber in the sryinge as described above.
    The other one your obviously using dosent :D

    Cheers Fella
    D;)
     
  29. mgates01

    mgates01 Active Member

    I've spoken to dentist friends who say the necessity to aspirate primarily arises from the use of LA with adrenaline, and the need to avoid introducing this directly into the bloodstream
    They argue that generally the way their injections are administered results in minimal risk of significant quantities of LA entering directly the bloodstream. A few I know have, however, taken the extra precaution of switching to plain scandonest as they claim that they are less concerned if some of this LA enters the blood stream as it is relatively innocuous!

    I would suggest this is probably a similar situation to our digital blocks in that the size of the blood vessels and the constant movement of the needle means that there should be minimal, if any LA deposited in a digital blood vessel.

    When carrying out a Post Tib block on the other hand these are much larger vessels and much larger quantities of LA. Needless to say you don't want to empty a full cartridge of LA directly into a Tibial vessel, (you won't get any anaesthesia for a start), hence the emphasis on aspirating in these instances.
    As all have said self aspirating syringes are the way to go now in modern practice so the question of whether to aspirate or not becomes somewhat redundant.

    I have to admit though I'm not sure I've ever come across a non-self aspirating cartridge ?

    regards
    Michael
     
  30. DTT

    DTT Well-Known Member

    Hi Michael
    yes agreed we dont use adrenaline on digital blocks anyway = a total contraindication where as dentists do on their end to prolong the anaesthesia .


    Yep your right but then again the question posed to me was somewhat ambiguous

    Hence the answer and explanation

    Cheers
    D;)
     
  31. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    There is NO reason what-so-ever to NOT use adrenaline in digital blocks, except in vasospastic conditions. ALL the evidence is clear that there is no risk. I have probably done close to 1000 digital blocks with adrenaline and NEVER had a problem.
     
  32. DTT

    DTT Well-Known Member

    Teaching Ive just had = adrenaline = vaso constrictor = risk of vasular occlusion in the digit = gangrene= law suit= definate no no.

    BUT

    That could be driven by the " barrister in the cupboard" mentality over here :wacko: (something I treat with suspicion and am not convinced is a reality in the real world unless it is accompanied by clinical stupidity / incompetance)

    But

    in all honesty clinically I dont know the answer to that ,in reality, you just have to go with what you have been taught and take heed of the warnings.

    BUT

    Why would you need to use adrenaline in a digital block ?? there are LA's that will numb a digit for 6 hours + without the need = why take the risk ?? just a thought
    Cheers Fella
    D;)
     
  33. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    We teach the opposite as the most recent meta analysis/systematic review of ALL of the evidence on digital injections is that its NOT a problem.

    The benefits of adrenaline = longer acting; less LA needed; less bleeding
     
  34. MJJ

    MJJ Active Member

    It's important to note that self-aspirating does not mean automatically aspirating. It is very easy to use a self-aspirating syringe and not aspirate. As was mentioned in an earlier post the aspiration happens when you release the syringe. To aspirate you push on the plunger slightly, stretching the rubber membrane at the business end, then release pressure. You don't have to be able to pull back on the plunger to aspirate, as you would with a regular syringe. I currently use the Septodont Ultra Safety Plus XL syringes and I really like them, you can aspirate as described above or by pulling the plunger.

    http://www.youtube.com/watch?v=Y3Juossg8Bw shows how aspiration is accomplished
     
    Last edited: Jul 16, 2012
  35. So it's the syringe, not the cartridge? What are differences in terms of the design of the actual cartridge itself? Or are all cartridges self-aspirating when placed into a self-aspirating syringe?
     
  36. blinda

    blinda MVP

    Yep.
    None.
    All cartridges can be used in a self aspirating system, as MJJ nicely explained. I use the same syringes. They're cool.
     
  37. Me too.
     
  38. DTT

    DTT Well-Known Member

    Me too ;)
    D;)
     
  39. This. The name is a little misleading. You don't have to actually draw back (well you can't!) but you do have to release the pressure on the plunger. The rubber relaxes and creates a very small negative pressure. So although its self aspirating you still have to stop and aspirate.

    Thats not made it clearer at all!:wacko:

    This also. Bit of common sense goes a long way.

    Its the design of the rubber bung which the syringe presses. When it gets pressed in it goes convex into the LA side and when you release the pressure it returns to flat. So far as I know all cartridges are designed this way.
     
  40. madmacaw

    madmacaw Member

    We were taught both methods. The uni uses the self-aspirating syringes whereas where I was on NHS placement use normal syringes. Just as well that we were taught to aspirate as on the NHS placement, I aspirated whilst doing a digital block and had obviously hit a vessel as had blood draw back into the barrel! Can't remember the gauge of the needle though - sorry.

    I prefer using the safety syringes now that I have got used to them but I did find them strange to start with. The main problem that I came across with the safety syringes was another student who has tiny hands and struggled to have the reach with her hands to use them.
     

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