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Armamen & Basic
Local Anesthetic Armamentarium and Basic Injection Technique
| Question | Answer |
|---|---|
| Label the parts of this syringe: **Refer to image What type of syringe is this, that we use in clinic? | Label the parts of this syringe: A. ____thumb ring_____ B. ____finger grip_____ C. ____spring_____ D. ____guide bearing_____ E. ____piston w/attached_____ F. ____harpoon_____ G. ____syringe barrel_____ H. ____needle adaptor____ Breech loading |
| Problem: Very Small Bubbles What is the cause? | Normal and harmless |
| Problem: Large Bubbles What is the cause? | >2mm cartridge was frozen at some point |
| Problem: Solution Clarity What is the cause? | May have overheated, soaked in disinfectant (absorbed in & contaminated), or expired and oxidized. |
| Problem: Cap Corrosion What is the cause? | Immersed in quaternary ammonium salts (cold sterile), wiped w/isopropryl alcohol to disinfect. |
| Problem: Rust What is the cause? | At least one cartridge in the metal container is cracked; distinguished from corrosion bc rust is red. |
| Problem: Leakage during injection What is the cause? | The needle is incorrectly screwed on, no straight, and puncture may be ovoid or off. |
| Problem: Extruded stopper w/bubble What is the cause? | Was frozen |
| Problem: Extruded stopper w/out bubble What is the cause? | Prolonged storage in chemical disinfectant |
| Problem: Broken/cracked cartridge What is the cause? | To rough handling or excessive force to engage harpoon. |
| Fill in the information about the needle based on the length and color of the cap: Short Red | Gauge 25, Range 20-25 mm (Avg 20 mm), %100 aspiration |
| Fill in the information about the needle based on the length and color of the cap: Long Red | Gauge 25, Range 30-35 mm (Avg 32 mm), %100 aspiration |
| Fill in the information about the needle based on the length and color of the cap: Short Yellow | Gauge 27, Range 20-25 mm (Avg 20 mm), %87 aspiration |
| Fill in the information about the needle based on the length and color of the cap: Long Yellow | Gauge 27, Range 30-35 mm (Avg 32 mm), %87 aspiration |
| Fill in the information about the needle based on the length and color of the cap: Short Blue | Gauge 30, Range 20-25 mm (Avg 20 mm), %2 aspiration |
| When would you use a 30 gauge needle in clinical practice? | In private practice they should be ONLY used for palatal infiltrations or PDL injections (decreased vasculature) |
| List/label the parts of the needle: **Refer to image | A. ____needle shaft_____ B. ____beveled tip_____ C. ____cartridge penetrating end_____ D. ____syringe adaptor_____ E. ____hub_____ F. ____needle cap_____ |
| What is the biggest concern with using a blue needle? Out of poor aspiration ability and deflection, which one is the bigger concern? | Biggest concern w/a blue needle is that it is unsafe and has a 2% aspiration rate. The aspiration ability is the bigger concern. |
| Which gauge of needle aspirates the most accurately? The least? List the percent of accuracy for each gauge related to correct aspiration results | The most accurate is the 25 gauge 100% aspiration rate. The least is the 30 gauge at 2%. The 27 gauge has an 87% aspiration rate. |
| Label the parts of the cartridge: what end does the needle puncture? What end does the harpoon puncture? **Refer to image | a. Cylindrical glass tube b. Stopper c. Aluminum cap d. Diaphragm |
| How many cc’s does 1 cartridge contain? How many ml’s is this? | 1.8 mL = 1.8 cc per cartridge |
| How many penetrations can each needle have (ideally)? | 3 is ideal |
| List the standard contents within a cartridge of local anesthetic and explain what they are used for: Distilled water | o Diluent – majority of solution |
| List the standard contents within a cartridge of local anesthetic and explain what they are used for: Local anesthetic | o Crystal form if not in solution |
| List the standard contents within a cartridge of local anesthetic and explain what they are used for: Vasoconstrictor drug | o If present, constriction of blood vessels |
| List the standard contents within a cartridge of local anesthetic and explain what they are used for: Metabisulfite preservation | o Prevent vaso from oxidizing (turning brown), only if vaso present. |
| List the standard contents within a cartridge of local anesthetic and explain what they are used for: Sodium Chloride | o Isotonic tissue compatibility |
| What is the bi-directional insertion technique and why is it used? | BRIT method requires rotating back and forth while inserting or during penetration w/a C-CLAD device, the deflection is neutral. |
| Name 2 reasons that the injection site should be debrided with gauze prior to placing topical and identify which is the more important reason? | 1. Essential to remove bacteria (more important) 2. Topical works better on dry tissue (less important) |
| After assembling the syringe, how should it rest on the table (what orientation)? | Place syringe: 1. Large window down 2. Where it will be easy to grab & recap |
| Can we wipe down unused glass cartridges with disinfectant after being contaminated by a patient’s saliva or placed on a dirty tray? What is the only solution we should use to wipe down a non-contaminated cartridge? | You should never wipe down a glass cartridge with disinfectant it might contaminate the cartridge, just throw in sharps. The ONLY solution we should use alcohol to wipe down a non-contaminated cartridge. |
| Write the likely cause/s and the prevention of each problem listed on the right: Solution leakage | Cause: Needle wasn't screwed in straight Prevention: insert properly |
| Write the likely cause/s and the prevention of each problem listed on the right: Burning | Cause: -Normal response -Cart has sterilizing sol -Overheated -Older cart w/vaso (oxidation of sodium metabisulfite to bisulfite) Prevention: buffering, checking cart not expired, don't heat |
| Write the likely cause/s and the prevention of each problem listed on the right: Harpoon Disengagement | Cause: -Too fast aspiration -Harpoon not engaged properly Prevention: -Make sure harpoon is fully engaged w/stop |
| Write the likely cause/s and the prevention of each problem listed on the right: Pain on needle insertion & withdrawal | Cause: Barbed or dull needle Prevention: New better quality sharp needle |
| Write the likely cause/s and the prevention of each problem listed on the right: Broken Cartridge | Cause: -Cracked cart -Excessive force in engaging harpoon -Bent harpoon -Using cart w/extruded stopper Prevention: Check harpoon and cartridge. Make sure syringe is assembled properly. |
| After assembling the syringe, how should it rest on the table (what orientation)? | Place syringe: 1. Large window down 2. Where it will be easy to grab & recap |
| What is the ideal rate of LA delivery? | 1 mL per min (about half cart in 60 sec) |
| How long should we aspirate? Why do we wait this long? | 3 seconds to avoid false negatives and a safety factor to avoid administering a large dose into a blood vessel. |
| Why is it recommended that clinicians aspirate in two planes? (may have to use text to answer); What are you taught at Pima to do in place of this? | Teach to rotate the syringe&aspirate in 2 planes to avoid false negatives. At Pima, taught to aspirate for 3 secs multiple times during an injection. It ensures patient safety and is a preventative measure. |
| At what point/s during an injection is aspiration necessary? List all: | 1. Initial penetration 2. At site/target 3. After half a stopper of LA has been administered |
| List the factors that contribute to deflection: | The needle deflects away from the way the bevel is facing. The greater: -the angle of the bevel -the deeper the thickness of soft tissue -the thinner the needle the greater the deflection. |
| If the harpoon disengages during aspiration, what must the clinician do? | Let the instructor know that “harpoon has disengaged” and withdraw. |
| What words should be avoided when communicating with patients about an injection? | Avoid the words: hurt, shot, pain, painless, bone |
| When assembling a syringe, should the needle or the cartridge be inserted first? When disassembling a syringe, which should be removed first, the needle or the cartridge? | Cartridge should be inserted first when assembling a syringe. When disassembling the cartridge should be removed first as well. |
| If a needle touches any surface besides the oral tissue, what needs to be done? | Disposal and a new needle for replacement |
| What should you check the syringe for after assembly but before administering to a patient? | After assembling, TEST IT OUT. Make sure flow is good and the harpoon is engaged. |
| How long should topical be left on the tissue? After removing, how soon should the injection occur according to 1. The class notes and 2. Many manufacturers? | Apply topical for at least 2-3 mins. Injection should be performed within 2 mins (class note) for ideal effectiveness & 15-20 mins (other sources). |
| Where and in what direction should you retract the tissue (esp. for maxillary facial injections)? | What direction should you pull the lip/tissue? Straight up from in vestibule Where in relation to the site? Directly above site Very tight or should there be some slack? Tissue at site must be tight How should you NOT retract? NOT obliquely |
| As you are preparing to inject, what are the things to think about/check/do? | Ck flow&harpoon, type of anesthetic, expiration date is good and showing, large window is optimal and towards you, palm up, thumb held back of thumb ring to avoid dripping, pre-folded gauze ready, no contaminations, and full visibility of injection site. |
| Answer the questions about fundamental local anesthetic techniques to the right: Where should your upper arm be? | Close or fairly close to body |
| Answer the questions about fundamental local anesthetic techniques to the right: Which direction should your palm be facing when holding the syringe for LA? | Facing Up |
| Answer the questions about fundamental local anesthetic techniques to the right: Where on the thumb should the thumb ring sit during LA administration? | thumb held back of thumb ring and above first knuckle. |
| Answer the questions about fundamental local anesthetic techniques to the right: Is it ever ok to bend the wrist? | Ok to bend wrist SLIGHTLY at certain times. |
| Answer the questions about fundamental local anesthetic techniques to the right: What is the “grasp for added stability” described in the handout? | Placing ring finger on the barrel can provide add stability. |
| How should you handle a positive aspiration? Specify the difference between large and small positives: Lots of blood | Withdraw and change cartridge |
| How should you handle a positive aspiration? Specify the difference between large and small positives: A slight bit of blood | Decide if you need to change the cartridge by your ability to recognize another positive aspiration. If too much blood and you cannot see another positive aspiration then withdraw and change cart. |
| When a positive aspiration is so small that withdrawal is not necessary, what are the next steps before depositing? How much movement is necessary? | Just shift the position, back up slightly and continue. Approx. 1mm. |
| When there is a positive aspiration, what is the crucial determinant in whether you reposition the needle or if totally withdraw? | That you can see another tiny positive w/100% certainty, you can reposition a little and keep going; otherwise, withdraw, change cartridge, and change your site slightly. |
Created by:
RDHSeattle