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?
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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 -
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! -
To aspirate or not?
Why not?
Patient had Toxic reaction - did you aspirate? - no, never do - oh really, why not?:butcher:
Dave -
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 -
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I've obviously been very lucky! -
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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. -
I'm clenching just from the memory :empathy: -
Self Aspirating Syringes =
The way to go :cool:
Cheers
D;) -
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 !!! -
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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;) -
Cheers
D;) -
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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;) -
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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?
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Cheers
D;) -
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
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Wots "probably "mean ??
How do I know what your using ??
JEEEEEEZ gimme a break :D:D
cheers
D;) -
27g here
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Just into the chamber at the other end of the sryinge just above where the needle connects.
Cheers
D;) -
"I don't know" should suffice.;) -
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;) -
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.
Cheers Fella
D;) -
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 -
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
Cheers
D;) -
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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;) -
The benefits of adrenaline = longer acting; less LA needed; less bleeding -
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 accomplishedLast edited: Jul 16, 2012 -
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None.
All cartridges can be used in a self aspirating system, as MJJ nicely explained. I use the same syringes. They're cool. -
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D;) -
Thats not made it clearer at all!:wacko:
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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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