scholarly journals Comparison of Intravascular Injection Rate Between Blunt and Sharp Needles During Cervical Transforaminal Epidural Block

2019 ◽  
Vol 3 (22;3) ◽  
pp. 265-270
Author(s):  
Saeyoung Kim
Keyword(s):  
Contrast Medium ◽  
Tertiary Hospital ◽  
Radicular Pain ◽  
Injection Rate ◽  
Epidural Block ◽  
Procedure Time ◽  
Intravascular Injection ◽  
Needle Position ◽  
Blunt Needle ◽  
Sharp Needle

Background: Cervical transforaminal epidural block (CTEB) is a useful option in the diagnosis and treatment of cervical radicular pain. However, inadvertent intravascular injection can lead to severe neurologic complications. Blunt needles are considered to displace instead of penetrate vessels because of their dull needle tip. Objectives: To investigate whether there is a difference between blunt and sharp needles in intravascular injection rates during CTEB. Study Design: Prospective, randomized, clinical trial. Setting: A tertiary hospital in South Korea. Methods: After institutional review board approval, 108 patients undergoing CTEB for treatment of radicular pain resulting from spinal stenosis and herniated nucleus pulposus were randomly assigned to one of 2 needle groups (blunt needle or sharp needle). The needle position was confirmed using biplanar fluoroscopy, and 2 mL of nonionic contrast medium was injected to detect intravascular injection. Intravascular injection was defined as the contrast medium spreading out through the vascular channel during injection under realtime fluoroscopy. This study was registered in ClinicalTrials.gov. Results: The intravascular injection rate was not significantly different between the blunt needle and sharp needle groups (35.2% vs. 33.3%, P > 0.05). The procedure time was longer in the blunt needle group than in the sharp needle group (101.00 ± 12.4 seconds vs. 56.67 ± 8.3 seconds, P < 0.001). Limitations: This was a single-center study. Additionally, the physicians could not be blinded to the type of needle used. Conclusions: In the present study, use of a blunt needle did not reduce the rate of intravascular injection during CTEB compared to use of a sharp needle. In addition, procedure time significantly increased with blunt needle use compared to sharp needle use. Key words: Analgesia, bleeding, blunt needle, cervical spine, clinical trials, complications, intravascular injection, radiculopathy, sharp needle, transforaminal epidural block

Comparison of Touhy and Quincke needles on intravascular injection rate in lumbar transforaminal epidural block: a randomized prospective trial

2021 ◽  
pp. rapm-2021-102504
Author(s):  
Hyojung Soh ◽  
Yujin Jeong ◽  
Eung Don Kim
Keyword(s):  
Steroid Injection ◽  
Prospective Trial ◽  
Injection Rate ◽  
Epidural Steroid Injection ◽  
Tuohy Needle ◽  
Spinal Cord Infarction ◽  
Procedure Time ◽  
Intravascular Injection ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

BackgroundTransforaminal epidural steroid injection is widely used in clinical practice to effectively deliver injectate into the ventral epidural space. Complications associated with intravascular injection such as spinal cord infarction and paraplegia can occur during transforaminal epidural steroid injection. To improve the safety of the procedure, avoidance of intravascular injection is crucial, for which appropriate needle selection is important. The primary aim of this study was to compare intravascular injection rates during transforaminal epidural steroid injection between commonly used Quincke and Tuohy needles.MethodTwo hundred and four transforaminal epidural steroid injection cases were randomly assigned to one of two needle groups (22-gage Quincke needle or 22-gage Tuohy needle). Intravascular injection was evaluated using digital subtraction angiography. Spread of contrast medium to the ventral and medial epidural spaces was evaluated. Procedure time was compared between the two needle types.ResultsThe overall incidence of intravascular injection was 7.8%. The rate of intravascular injection was significantly lower in the Tuohy needle group than the Quincke needle group (2.9% vs 12.7%, p=0.009). The ventral and medial epidural spread rates of the Tuohy needle group were 92.2% and 95.1%, respectively, significantly higher than those of the Quincke needle group. The procedure time was shorter in the Tuohy needle group than in the Quincke needle group (97.4 (19.3) seconds vs 117.8 (31.9) s; mean difference −20.40 (95% CI −34.35 to −6.45), p=0.005).ConclusionsIn conclusion, Tuohy needles had a lower intravascular injection rate and higher medial and ventral epidural spreading rates than Quincke needles.Trial registration numberKCT0002095.

scholarly journals Fusion Imaging of X-ray and Transesophageal Echocardiography Improves the Procedure of Left Atrial Appendage Closure

2020 ◽  
Vol 34 (6) ◽  
pp. 781-787
Author(s):  
Henning Ebelt ◽  
Thomas Domagala ◽  
Alexandra Offhaus ◽  
Matthias Wiora ◽  
Andreas Schwenzky ◽  
...  
Keyword(s):  
Contrast Medium ◽  
Transesophageal Echocardiography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Fusion Imaging ◽  
Atrial Appendage ◽  
Final Position ◽  
Procedure Time ◽  
Left Atrial Appendage Closure ◽  
X Ray

Abstract Background Left atrial appendage closure (LAAC) is an alternative treatment strategy for patients with atrial fibrillation who are at risk for thromboembolic events and considered not suitable for oral anticoagulation (OAC). LAAC is mainly performed under the guidance of transesophageal echocardiography (TEE) and fluoroscopy. The study presented here should analyze whether fusion imaging (FI) of transesophageal echocardiography and X-ray performed during LAAC is feasible and can improve the results of the procedure. Methods The data presented here are from a retrospective single center study. Sample size was defined as 50 patients in which LAAC was performed without fusion imaging (control group) and 25 patients were the LAAC procedure was guided by fusion imaging (treatment group). Inclusion criteria were defined as age > 18 years and completion of an LAAC procedure defined as deployment of a WATCHMAN 2.5 LAA occluder. Study endpoints were procedure time, amount of used contrast medium, radiation dose, final position of the WATCHMAN in TEE (deviation from ideal positioning), and clinical endpoints, respectively. Results LAA closure was successfully performed in all patients. No case of device embolism was occurring, and none of the patients experienced a periprocedural stroke/TIA nor a systemic embolism, respectively. Mean procedure time was 15 min shorter in the group of patients where fusion imaging was applied (p < 0.001). Additionally, the use of fusion imaging was associated with a significant reduction of contrast medium (20.6 ml less than in control; p < 0.045). Regarding the final position of the WATCHMAN, no relevant differences were found between the groups. Summary The use of fusion imaging significantly reduced procedure time and the amount of contrast medium in patients undergoing LAAC.

Aortic dual-energy CT angiography with low contrast medium injection rate

2014 ◽  
Vol 22 (5) ◽  
pp. 689-696 ◽  
Author(s):  
Jie Liu ◽  
Pei-Jie Lv ◽  
Runze Wu ◽  
Yong-Gao Zhang ◽  
Li-Li Hu ◽  
...  
Keyword(s):  
Contrast Medium ◽  
Ct Angiography ◽  
Dual Energy ◽  
Injection Rate ◽  
Dual Energy Ct ◽  
Low Contrast ◽  
Contrast Medium Injection ◽  
Low Contrast Medium

scholarly journals Ultrasound-Guided Selective Nerve Root Block versus Fluoroscopy-Guided Interlaminar Epidural Block versus Fluoroscopy-Guided Transforaminal Epidural Block for the Treatment of Radicular Pain in the Lower Cervical Spine: A Retrospective Comparative Study

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Jin Hyuk Jang ◽  
Woo Yong Lee ◽  
Jong woo Kim ◽  
Kyoung Rai Cho ◽  
Sang Hyun Nam ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Retrospective Study ◽  
Steroid Injection ◽  
Treatment Success ◽  
Radicular Pain ◽  
Epidural Block ◽  
Functional Improvement ◽  
Lower Cervical Spine ◽  
Selective Nerve Root Block ◽  
Epidural Steroid

Background. Recently, ultrasound- (US-) guided selective nerve root block (SNRB) has been reported to have similar effects compared to fluoroscopy- (FL-) guided cervical epidural steroid injection (CESI). There is no published study comparing the therapeutic efficacy and safety of interlaminar- (IL-) CESI and transforaminal- (TF-) CESI with US-guided SNRB. Our retrospective study aimed to compare the mid-term effects and advantages of the US-guided SNRB, FL-guided IL-CESI, and TF-CESI for radicular pain in the lower cervical spine through assessment of pain relief and functional improvement. Methods. Patients with radicular pain in the lower cervical spine who received guided SNRB (n = 44) or FL-guided IL (n = 41) or TF-CESI (n = 37) were included in this retrospective study. All procedures were performed using a FL or US. The complication frequencies during the procedures, adverse event, treatment effects, and functional improvement were compared at 1, 3, and 6 months after the last injection. Results. Both the Neck Disability Index (NDI) and Verbal Numeric Scale (VNS) scores showed improvements at 1, 3, and 6 months after the last injection in all groups, with no significant differences between groups P<0.05. Furthermore, the treatment success rate at all time points was not significantly different between groups. Logistic regression analysis revealed that the injection method (US- or FL-guided), cause, sex, age, number of injections, and pain duration were not independent predictors of treatment success. Blood was aspirated before injection in 7% (n = 3), 14% (n = 6), and 0% patients in the FL-guided IL, TF, and US-guided groups, respectively. In 2 patients of FL-guided IL and 7 of FL-guided TF group, intravascular contrast spread was noted during injection. Conclusions. Our results suggest that, compared with FL-guided IL and TF-CESI, US-guided SNRB has a low intravascular injection rate; it is unlikely that serious complications will occur. Also, US-guided SNRB requires a shorter administration duration while providing similar pain relief and functional improvements. Therefore, for the treatment of patients with lower cervical radicular pain, US-guided SNRB should be considered as a prior epidural steroid injection.

Effect of Injection Rate Shaping Over Diesel Spray Development in Non Reacting Evaporative Conditions

2012 ◽  
Author(s):  
Raul Payri ◽  
Jaime Gimeno ◽  
Michele Bardi ◽  
Alejandro Plazas
Keyword(s):  
Fuel Injection ◽  
Cone Angle ◽  
Injection Rate ◽  
Effective Diameter ◽  
Spray Cone Angle ◽  
Spray Cone ◽  
Test Conditions ◽  
Needle Position ◽  
Rate Shaping ◽  
Wide Range

A prototype Diesel common rail direct-acting piezoelectric injector has been used to study the influence of fuel injection rate shaping on spray behavior (liquid phase penetration) under evaporative and non-reacting conditions. This state of the art injector allows a fully flexible control of the nozzle needle, enabling various fuel injection rates typologies under a wide range of test conditions. The tests have been performed employing a novel continuous flow test chamber that allows an accurate control on a wide range of thermodynamic test conditions (up to 1000 K and 15 MPa). The temporal evolution of the spray has been studied recording movies of the injection event with a fast camera (25 kfps) by means of the Mie scattering visualization technique. The analysis of the results showed a strong influence of needle position on the behavior of the liquid length. The needle position controls the effective pressure upstream of the nozzle holes. Higher needle lift is equivalent to higher effective pressures. According to the free-jet theory, the stabilized liquid-length depends mainly on effective diameter, spray cone-angle and fuel/air properties and does not depend on injection velocity. Therefore, higher injection pressures gives slightly lower liquid length due to small change in the spray cone-angle. However, partial needle lifts has an opposite effect: lower effective pressure upstream of the nozzle holes shows a dramatic increase on the spray cone-angle, reducing the liquid length. This behavior could be explained mainly due to the fact that the flow direction upstream of the nozzle holes is affecting the area coefficient, or in other words, the effective diameter of the holes.

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