Sonographic needle guidance significantly improves the performance and outcomes of outpatient IA injections in a clinically significant manner.

Purpose Syringes are used for diagnostic fluid aspiration and fine needle aspiration biopsy (FNA) in interventional procedures. We determined the benefits, disadvantages, and patient safety implications of syringe and needle size on vacuum generation, hand force requirements, biopsy/fluid yield, and needle control during aspiration procedures. Materials and Methods Different sizes (1, 3, 5, 10, and 20 ml) of the conventional syringe and aspirating mechanical safety syringe, the reciprocating procedure device (RPD), were studied. 20 operators performed aspiration procedures with the following outcomes measured: 1) vacuum (Torr), 2) time to vacuum (seconds), 3) hand force to generate vacuum (Torr-cm2), 4) operator difficulty during aspiration, 5) biopsy yield (mg), and 6) operator control of the needle tip position (mm). Results Vacuum increased tissue biopsy yield at all needle diameters (p < 0.002). 20 ml syringes achieved a vacuum of −517 Torr, but required significantly more strength to aspirate, and resulted in significant loss of needle control (p<0.002). The 10 ml syringe generated only 15% less vacuum (−435 Torr) than the 20 ml, and required much less hand strength. The mechanical syringe generated identical vacuum at all syringe sizes with less hand force (p<0.002), and provided significantly enhanced needle control (p<0.002). Conclusions To optimize patient safety and control of the needle and maximize fluid and tissue yield during aspiration procedures, a two-handed technique and the smallest syringe size adequate for the procedure should be used. If precise needle control or one-handed operation is required, a mechanical safety syringe should be considered.

Objective. To identify and integrate new safety technologies into outpatient musculoskeletal procedures and measure the effect on outcome, including pain.Methods. Using national resources for patient safety and literature review, the following safety technologies were identified: a safety needle to reduce inadvertent needlesticks to heath care workers, and the reciprocating procedure device (RPD) to improve patient safety and reduce pain. Five hundred sixty-six musculoskeletal procedures involving syringes and needles were randomized to either an RPD group or a conventional syringe group, and pain, quality, safety, and physician acceptance were measured.Results. During 566 procedures, no accidental needlesticks occurred with safety needles. Use of the RPD resulted in a 35.4% reduction (95% confidence interval [95% CI] 24-46%) in patient-assessed pain (mean ؎ SD scores on a visual analog pain scale [VAPS] 3.12 ؎ 2.23 for the RPD and 4.83 ؎ 3.22 for the conventional syringe; P < 0.001) and a 49.5% reduction (95% CI 34-64%) in patient-assessed significant pain (VAPS score >5) (P < 0.001). Physician acceptance of the RPD combined with a safety needle was excellent.Conclusion. As mandated by the Joint Commission and the Occupational Safety and Health Administration, safety technologies and the use of pain scales can be successfully integrated into rheumatologic and orthopedic procedures. The combination of a safety needle to reduce needlestick injuries to health care workers and the RPD to improve safety and outcome of patients is effective and well accepted by physicians.Injuries to patients and health care workers during and after physician-performed procedures are considerable and are among the greatest risks to the safety of patients and health care workers yet are challenging to prevent, requiring changes in both behavior and medical technology (1-22). The Joint Commission, the Needlestick Safety and Prevention Act, and the Occupational Safety and Health Administration all direct health care entities, including rheumatology and orthopedics services, to develop formal mechanisms to improve patient and health care worker safety and outcomes, including but not limited to integration of new safety technologies and routine pain assessment (1-5). Improvement in the safety design of medical instruments through safety engineering is one of the most robust methods to improve patient safety and reduce iatrogenic injuries to patients and needlesticks to health care workers (1-4,9-12). To date, however, few rheumatology or orthopedics departments have formally

For greater safety and control when operating the conventional syringe, smaller syringe sizes and 2 hands instead of 1 hand should be used whenever possible. If 1-handed operation of a syringe is necessary, a safety technology like the RPD control syringe should be used.