1
Q
what 3 components do we need for anesthetic armamentarium
A
- aspirating syringe
- disposable sterile needle
- single-dose anesthetic cartridge
2
Q
what supplemental armamentarium is needed for anesthetic application
A
- topical antiseptic (optional)
- topical anesthetic
- applicator sticks
- gauze
- hemostat or cotton pliers
- needle capping aid
3
Q
what is the advantage and purpose of the harpoon
A
- to provide negative pressure inside the anesthetic cartridge when the thumb ring is pulled back by the clinician. this causes retraction of the rubber stopper
- assuming the needle has an adequate gauge, blood will enter the cartridge following the negative pressure exerted on the thumb right, thus signalling the clinician that a positive aspiration has occurred (don’t want this – need to see negative aspiration before depositing anesthetic)
4
Q
what is a breech-loading metallic cartridge type
A
- reusable syringe
- most commonly used syringe type today
- harpoon = aspirating
- needle attached to barrel of syringe at the needle adapter
- end of needle penetrates barrel of syringe and pierces rubber diaphragm on the cartridge
- aspirating tip or harpoon used to penetrate thicker rubber stopper
- when negative pressure is exerted on the thumb ring, blood will enter the needle lumen and cartridge if in blood vessel
5
Q
what are the advantages to using a reusable breech-loading metallic syringe type
A
- readily visible cartridge
- ease of aspiration with one hand
- autoclavable
- rust resistant
- long lasting with proper maintenance
6
Q
what are the disadvantages to using a reusable breech-loading metallic syringe type
A
- weight (heavy)
- size – may be too big for small hands
- possibility of infection with improper care
7
Q
what is a breech-loading metallic cartridge self-aspirating
A
- obtains negative pressure for aspiration by means of the elasticity of the rubber diaphragm of the cartridge
- the diaphragm rests on a metal projection inside the syringe which directs the needle into the cartridge
- pressure acting directly through the plunger shaft stretches the rubber diaphragm
- when pressure is released, sufficient negative pressure is produced within the cartridge to achieve aspiration
8
Q
which of the 2 methods of aspiration produces twice as much negative pressure compared to the other
A
- the thumb ring
9
Q
which of the 2 methods of aspiration permits easy, multiple aspirations throughout the period of local anesthetic deposition
A
- the self aspirating
- highly recommended
10
Q
what are the advantages to using a breech-loading metallic cartridge type, self aspirating syringe
A
- readily visible cartridge
- ease of aspiration with small hands
- disengagement of harpoon from rubber stopper cannot occur
- autoclavable
- rust resistant
- long lasting
11
Q
what are the disadvantages to using a breech-loading metallic cartridge type, self aspirating syringe
A
- weight (heavy)
- feeling of insecurity for those used to the harpoon
- possibility of infection with improper care
12
Q
what is a pressure-type syringe
A
- aka intraligamentary syringe
- introduced in the late 1970s
- used for periodontal ligament injections
13
Q
what 4 things can we do to care for syringes properly
A
- thorough cleaning and sterilization, then autoclave
- periodically dismantled and lubricated with a light oil (every 5 uses)
- replace piston and harpoon as needed
- clean the harpoon with a brush after each use
14
Q
what kind of problems can we run into with syringes
A
- leakage during injection
- cartridge breakage
- bent harpoon
- disengagement of harpoon from plunger during aspiration
- surface deposits
15
Q
what can occur to cause leakage during injection
A
- when reloading a syringe with a second cartridge, and the needle is already in place, one should be sure that the needle penetrates the centre of the rubber diaphragm
- an off center perforation will produce an overall puncture of the diaphragm that permits leakage of the anesthetic solution around the outside of the metal needle and into pt’s mouth
16
Q
what can occur to cause a cartridge breakage
A
- a badly worn syringe may damage the cartridge, leading to breakage
- this can also result from a bent harpoon
- a needle that is bent at its proximal end, not perforating the diaphragm on the cartridge, can be a problem
- positive pressure on the thumb ring increase intracartridge pressure which can lead to cartridge breakage
17
Q
what can happen if we have a bent harpoon
A
- the harpoon must be straight and sharp
- a bent harpoon produces an off center puncture of the rubber plunger causing the plunger to rotate as it moves down the glass cartridge
- this may occasionally result in cartridge breakage
18
Q
what can cause disengagement of the harpoon from the plunger during aspiration
A
- occurs if the harpoon is dull or if administrator applies too much pressure to the thumb ring during aspiration
- harpoon should be cleaned and sharpened or replaced
19
Q
how can we deal with surface deposits
A
- accumulations of debris, saliva, and disinfectant solutions interfere with syringe function and appearance
- deposits resembling rust can be removed with thorough scrubbing
- ultrasonic cleaning will not harm syringes
20
Q
what is the bevel
A
- point or tip of the needle
- defined by manufacturer as long, medium or short
- the greater the angle of the bevel with the long axis of the needle, the greater the deflection as needle is passed through soft tissue
21
Q
what is the shank
A
- aka the shaft
- consists of the diameter of the needle lumen (needle gauge) and the length of the shank from the point to the hub
22
Q
what is the hub
A
- plastic or metal piece through which the needle is attached to syringe
23
Q
what is the syringe end of the needle
A
- placed into the needle adaptor of the syringe
- pierces the rubber diaphragm of the glass cartridge (the needle we attach and discard after injection)
24
Q
what is the gauge
A
- refers to the internal diameter of the needle (lumen size)
- the smaller the gauge number, the larger the diameter of the needle - 25, 27, 30
- trend to use 30 g needles for greater patient comfort, however studies showed pt could not differentiate between different gauges
25
what is an advantage of a larger gauge
- less deflection
- less chance of needle breakage
- aspiration easier
26
when would it be most appropriate to use the following gauges
- 25 g should be used when high risk of positive aspiration (ei, PSA and IA)
- 27 g can be used where no risk of deflection or aspirarion
- 30 g is not recommended
27
how long is a short needle
- approx. 20 mm
28
how long is a long needle
- approx. 32 mm
29
how is selection of the length of needles determined
- based on the amount of tissue that needs to be penetrated to reach the target location and to deposit the anesthetic successfully
- short needles deflect less
30
how far in can we insert the needle
- NEVER insert a needle to the hub
31
how often should we change the needle
- every 3-4 injections on the same patient (starts to get dull)
32
what is the protocol for after we are finished with a needle
- cover the needle immediately after the administration of the injection
- constant awareness of the needle tip
- destroy needles after use (sharps container)
- never discard contaminated needles into trash container
33
what are some complications associated with needles
- pain on insertion
- pain on withdrawal
- needlestick exposure to the administrator
- needle breakage
34
what can cause pain on insertion
- dull needles
35
what can cause pain on withdrawal
- barbed bevel - either a manufacturing issue or, more commonly, caused by clinical contacting bone
36
how can we avoid needlestick exposures
- always recap between usage
37
what can cause needle breakage
- bending the needle
- sudden direction changes
- forcing the needle against resistance
- inserting the needle to the hub
- always use sterile disposable needles
38
how much anesthetic can each glass cylinder hold
- 1.8 ml of anesthetic solutions
39
what are the 4 parts of the cartridges
1. cylindrical glass tube
2. rubber stopper
3. aluminum cap
4. rubber diaphragm
40
what is the function of the rubber stopper
- occupies 0.2 ml of total volume
- receives harpoon of syringe
- silicone to avoid sticky stopper
- slightly indented from lip of glass cylinder, if not... discard
41
what is the function of the aluminum cap
- fits tightly around the neck of the glass cartridge holding thin rubber diaphragm in position
- silver coloured on all cartridges
42
what is the function of the rubber diaphragm
- permeable membrane through which end of needle penetrates (diffusion of contamination solutions)
- hole should be centrically located
- improper insertion of needle and cartridge can cause leakage during injection
43
what are the 5 contents of the cartridge
1. local anesthetic drug
2. vasoconstrictor drug
3. preservative for vasoconstrictor (sodium bisulphite)
4. sodium chloride (to make solution isotonic or equal osmotic pressure with body tissues)
5. distilled water (dilutes the solution)
44
what is the recommended care and handling of anesthetic cartridges like
- store in original container at room temperature in a dark place (keep in blister pack until ready to use)
- should not be autoclaved, heat will destroy vasoconstrictors
- commercial cartridge warmers are not necessary
- does not need to be 'prepared' (if wipe... use alcohol)
- notice expiration date; discard if past date
- read the manufacturer's insert
- never store cartridges in any solution (can penetrate the rubber diaphragm and mix into the solution)
- never warm cartridges
- do not store in direct sunlight
45
what are some problems we may see with cartridges
1. bubbles in cartridges
2. extruded stopper
3. burning on injection
4. sticky rubber stoppers (rare because of the use of silicone lubricant)
5. corroded cap
6. rust on cap
7. leakage during injection
8. broken cartridge
46
what can cause bubbles in the cartridge
- small bubbles (1-2 mm) of nitrogen gas which is bubbled into LA during manufacturing to prevent oxygen from being trapped in cartridge
- not always present
- larger bubbles with plunger extending beyond end are caused by freezing, should be returned
47
what can cause an extruded stopper
- caused by freezing
- no longer sterile and should not be used
- return to manufacturer
- will usually have large bubbles
- if no bubbles, could be contaminated
48
what can cause burning on injection
- normal response to pH of drug
- cartridge contamination
- overheated cartridge
- vasoconstrictor (will only last a few seconds)
- expired cartridge
49
what can cause a corroded cap
- aluminum caps will corrode if immersed in certain disinfectants
- do not use if corroded
50
what can cause rust on a cap
- indicates broken cartridge in container
- should not be used
- check all other cartridges in container
51
what can cause leakage during an injection
- occurs when cartridge and needle are not prepared properly (not centered)
- usually occurs when cartridge is placed after needle)
52
what can cause a broken cartridge
- cracked or chipped cartridge is most common cause (shipment error)
- return damaged boxes or examine remainder
- if cracked, pressure applied, may explode or shatter
- never hit thumb ring
- bent harpoon may break cartridge
- never force LA against resistance
53
what are the steps to follow in preparing a breech-loading aspirating syringe
1. based on treatment to be performed and patient medical history, select appropriate local and topical anesthetics and appropriate armamentarium
2. carefully evaluate the local anesthetic cartridge
3. optional to wipe rubber diaphragm with disinfectant
4. retract piston of syringe
5. insert cartridge with the rubber stopper going into the syringe first
6. engage the harpoon into the plunger
7. attach the needle
8. uncap the needle and expel a few drops
9. scoop the protective shield back onto the needle
54
how do we unload the breech-loading aspirating syringe
- remove the needle and discard it in the approved sharps container
- recommended not to recap the cartridge penetrating end of the needle
- avoid inadvertently discarding the needle adapter
- should the needle adapter remain attached to the needle, remove it with pliers
- dispose of the cartridge in a sealed container
Pain Management
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