Delivering A Successful Injection

Atraumatic Injections• Technique• Communication

with the patient

Use a Sterile Sharp Needle

• Use the same needle for a maximum of 3-4 injections.

• Each injection dulls the needle, pain and or discomfort can be noticed with each penetration of the same needle

• Gauge of needle (25-30)

Check Flow of Anesthetic Solution

• Expel a few drops of anesthetic from the cartridge

To warm or not to warm the cartridge

• No need to warm cartridge if stored at room temperature

• If a warmer is used, excess heat applied to the cartridge can cause pain upon deposition of anesthesia

Patient Positioning

• Position the patient so the head and heart parallel to the floor (may help prevent syncope)

Dry the Tissue • Dry the tissue in and

around the injection site (optional)

• Dry tissue will make it easier for the operator to retract tissue or to pull the tissue taut

Apply Topical Anesthetic

• Apply local anesthetic to the area of injection only for 1-2 minutes for patient comfort

Taut Tissue is a Must • Taut tissue allows the

needle penetration with minimal resistance

• Looses tissues are pushed and torn by the needle

Keep Syringe Out of Patient’s View

• Reduced anxiety prior to actual injection

Insert Needle into Mucosa• Insert needle gently into

the tissue

• With proper positioning and tissue preparation, the insertion can be almost painless

Observation and Communication

Observe patient nonverbal communication during the injection, checking for

potential discomfort

Inject Several Drops of Anesthetic

This step is optional, but as the area becomes anesthetized the patient will

be more comfortable

Slowly Advance the Needle to Target

• Operator may elect to deposit a few drops of anesthetic while advancing toward the target

• Needle penetration is rarely uncomfortable as the operator guides the needle to the target location

Aspirate • ALWAYS aspirate prior to deposition of anesthetic• The reason for aspiration is to determine if the

needle is in a blood vessel prior to deposition of anesthesia.

• To aspirate a negative pressure must be created within the cartridge

• Aspiration reduces the possibility of an intravascular injection

Positive Aspiration• To prevent an intravascular

injection, always use an aspirating syringe and aspirate

• Exact location of the needle tip is impossible without aspirating

What should the operator do it a positive aspiration is achieved while delivering an

injection?

Slowly Deposit Anesthetic

• Slowly deposit anesthesia results in less discomfort for the patient, safety, prevents solution from tearing the tissue

What’s a Slow Injection?• Deposition of 1 ml of anesthetic solution in

approximately 60 seconds is ideal

• As a practical matter, it should take approximately 60 seconds to deposit a full cartridge (1.8 ml)

Chart WritingUpdate- no changes in patient medical history

.9 ml 3% Mepivacaine Plain, local infiltration tooth #7 with 20% benzocaine topical anesthetic gel placed in injection site 2

minutes prior to injection

Patient tolerated the procedure well

Giving a Successful Injection Quiz

1. What should be done prior to inserting the needle into the tissue during an injection?

a. A few drops of solution should be expelled from the needle

b. Aspirationc. Warm the cartridged. Warn the patient that it will hurt

2. When giving an injection, what is done to prevent syncope?

a. Place the patient uprightb. Shake the tissue as you insert the needlec. Aspirationd. Place the patient in a supine position

3. What is the recommended length of time to apply topical anesthesia to the injection site?

a. 15 seconds b. 1-2 minutes c. 3 minutes d. 5 minutes

4. If done properly, the needle insertion and withdrawal during most injections should not cause pain to the patient.

a. True b. False

5. Why would you dry the tissue before giving an injection?

a. To remove any gross debrisb. To make retraction easierc. To help prevent bleedingd. The topical anesthetic will work fastere. a and b

6. The bevel of the needle should always be oriented:

a. Away from the bone b. Toward the bone c. Toward the tissue d. It doesn’t matter where the bevel is

7. Too much pressure while aspirating can cause:

a. The harpoon to disengage b. The cartridge to break c. Anesthetic solution to leak out d. Pain to the patient

8. How often should the needle be changed while giving local anesthesia injections?

a. Every injection b. Every 2 injections c. Every 3-4 injections d. Every 6 injections

9. How fast should anesthetic should be deposited for patient comfort?

a. 1ml in 15 seconds b. 1ml in 30 seconds c. 1ml in 60 seconds d. 1ml in 3 minutes

10. If the anesthetic solution is too warm, what may happen?

a. It will not be effective b. You will get a positive aspiration c. The patient may experience pain

upon injection