A Randomized, Controlled Trial of the Reciprocating Procedure Device for Local Anesthesia

Nunez, Sharon E; Bedrick, Edward J.; Kettwich, Sharon C.; Kettwich, Lawrence G.; Bankhurst, Arthur D.; Sibbitt, Wilmer L.

doi:10.1016/j.jemermed.2007.08.060

Cited by 15 publications

(35 citation statements)

References 32 publications

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“…All products used in these procedures were commercially available, FDA-approved, and used on-label. The purpose of this study was to describe the use of a new safety device, previously described for other applications [7][8][9][10] for central venous access procedures [1][2][3][4][5][6]. A total of 19 adult subjects who required central venous access were studied between the two institutions, and 6 different physicians used the devices.…”

Section: Case Reportmentioning

confidence: 99%

“…The safety technology of the reciprocating procedure device (RPD) is currently available in the one, three, 5,10, and 20 mL sizes (RPD-1, RPD-3, RPD-5, RPD-10; AVANCA Medical Devices, Inc., Albuquerque, NM; website: www.AVANCAMedical.com). The RPD is formed around the core of a conventional syringe barrel and plunger, but has an extra plunger and barrel [7][8][9]. The two plungers are mechanically linked by a pulley system in an opposing fashion, resulting in a set of reciprocating plungers.…”

Section: Case Reportmentioning

confidence: 99%

“…1 and 2). These characteristics of stable finger positioning and the exclusive use of the intrinsic flexor musculature create a powerful and finely controlled one-handed procedure syringe that precisely controls the needle tip position, strength of vacuum, and depth of penetration [7][8][9][10].…”

Section: Case Reportmentioning

confidence: 99%

“…After the RPD was removed, the wire was introduced. As in other procedures, operator satisfaction with the safety device was high because the RPD could be operated with one hand while aspirating and simultaneously maintaining precise needle control without unintentionally advancing the needle tip forward into non-target tissue, a hazard that causes many of the serious complications of central venous access [1][2][3][4][5][6][7][8][9][10]. Physicians did have to adapt to the "push-push" of the plungers of the RPD to alternatively inject-aspirate, instead of the usual "pushpull" with the conventional syringe; thus, the RPD did significantly change the technique of syringe use during vascular access.…”

Section: Case Reportmentioning

confidence: 99%

“…The syringe is operated with one or two hands, and the needle is advanced while aspirating, usually with ultrasound direction or the use of anatomic landmarks [2]. The aspiration phase with a syringe is a difficult and dangerous maneuver, and even experienced operators may lose control of the needle tip, resulting in unintentional forward penetration as much as several centimeters, causing puncture of the carotid artery, hemorrhage, hematoma formation, respiratory compromise, and other complications of central venous access [1,2,[7][8][9][10]. The feasibility of integrating new safety technologies into central venous access procedures is presented.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Introduction of new safety technologies into central venous access

Gerstein

Martin

Toma

et al. 2009

Journal of Clinical Anesthesia

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Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Introduction of new safety technologies into central venous access

Gerstein

Martin

Toma

et al. 2009

Journal of Clinical Anesthesia

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Integration of safety technologies into rheumatology and orthopedics practices: A randomized, controlled trial

Bedrick

Michael

Peisajovich

et al. 2008

Arthritis & Rheumatism

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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

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Image-Directed Fine-needle Aspiration Biopsy of the Thyroid with Safety-engineered Devices

Sibbitt

Palmer

Sibbitt

et al. 2010

Cardiovasc Intervent Radiol

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Purpose The purpose of the present study was to integrate safety-engineered devices into outpatient fine needle aspiration (FNA) biopsy of the thyroid in an interventional radiology practice. Materials and Methods The practice center is a tertiary referral center for image directed FNA thyroid biopsies in difficult patients referred by the primary care physician, endocrinologist, or otolaryngologist. As a departmental quality of care and safety improvement program, we instituted integration of safety devices into our thyroid biopsy procedures, and determined the effect on outcome (procedural pain, diagnostic biopsies, inadequate samples, complications, needlesticks to operator, and physician satisfaction) before institution of safety devices (54 patients) and after institution of safety device implementation (56 patients). Safety devices included 1) a patient safety technology - the mechanical aspirating syringe (reciprocating procedure device), and 2) a healthcare worker safety technology (anti-needlestick safety needle). Results FNA of thyroid could be readily performed with the safety devices. Safety-engineered devices resulted in a 49% reduction in procedural pain scores (p<0.0001), a 56% reduction in significant pain (p<0.002), a 21% increase in operator satisfaction (p<0.0001), and a 5% increase in diagnostic specimens (p=0.5). No needlesticks to healthcare workers or patient injuries occurred during the study. Conclusions Safety-engineered devices to improve both patient and healthcare worker safety can be successfully integrated into diagnostic FNA of the thyroid while maintaining outcomes and improving safety.

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A Randomized, Controlled Trial of the Reciprocating Procedure Device for Local Anesthesia

Cited by 15 publications

References 32 publications

Introduction of new safety technologies into central venous access

Introduction of new safety technologies into central venous access

Integration of safety technologies into rheumatology and orthopedics practices: A randomized, controlled trial

Image-Directed Fine-needle Aspiration Biopsy of the Thyroid with Safety-engineered Devices

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