Arterial Penetration With Blunt-Tipped Cannulas Using Injectables: A False Sense of Safety?

Sensitivity of aspiration as a safety test before injection of soft tissue fillers

“… Take caution when practicing aspiration as a negative test result (no blood in needle hub) might be false negative and give the injector a false sense of security; When injecting with a sharp point needle, a retrograde technique should be used when the product is released. In the event that the needle penetrates an artery, only a limited amount of product would then be released intra‐arterially; Avoid large‐volume bolus injections with the needle in a static position to avoid occlusion of a large area of the arterial system; Avoid high‐pressure injections as these may lead to retrograde flow against the arterial blood flow into a proximal arterial system (like the ophthalmic artery); Although nontraumatic cannulas can penetrate arterial walls, we recommend using cannulas over needles, and with diameters of 25G and larger to reduce the possibility of penetrating arterial walls; When choosing periosteal bolus injections with a needle, multiple small boluses (0.05 mL per bolus or less) with low pressure should be used. When injecting in the periorbital area (eg, close to the supratrochlear artery), smaller boluses should be used (<0.04 mL) as intravascular injection in this region can cause blindness. …”

“…• Although nontraumatic cannulas can penetrate arterial walls, 21 we recommend using cannulas over needles, and with diameters can be of great value in clinical practice, we caution practitioners not to rely on the validity of a negative test result (no blood in the needle hub) due to the high probability of a false-negative result.…”

Nonsurgical jawline rejuvenation using injectable fillers

“…Intravascular injection of filler results in pain and blanching along the distribution of the artery, which leads to tissue ischemia, necrosis, and rarely stroke and blindness . High‐risk areas include the glabella, nasal bridge, and nasolabial folds, yet filler‐induced vascular injury can occur anywhere on the face .…”

“…Intravascular injection of filler results in pain and blanching along the distribution of the artery, which leads to tissue ischemia, necrosis, and rarely stroke and blindness . High‐risk areas include the glabella, nasal bridge, and nasolabial folds, yet filler‐induced vascular injury can occur anywhere on the face . At the onset of any warning sign of vascular occlusion, the practitioner should immediately infiltrate the area of pending necrosis with injectable hyaluronidase, apply warm compresses, and consider administering aspirin, topical nitroglycerin, hyperbaric oxygen, and/or low molecular weight heparin .…”

Guidleine Implementation for Dermal Filler Administration Via Blunt-tip Cannula to Decrease Post-Procedure Hematoma Formation

“…Although no specific clinical trials or studies have demonstrated cannula use completely prevents AE, cannula use is recommended to decrease AE events (Yeh, Fabi, & Welsh, 2017). Additional techniques shown to decrease pain, bruising and AE include aspiration before injection, retrograde injection, slow speed of injection, and reduced ejection force (Glogau & Kane, 2008).…”