armamentarium for LA.pptx

8/14/2019 armamentarium for LA.pptx

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Armamentarium for

Local Anesthesia


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The Armamentarium4 PARTS :1) The Syringe2) The Needle3) The Cartridge4) Preparation


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THE SYRINGE


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Types of Syringes1) Non-disposable syringesa. Breech-loading, metallic, cartridge-type, aspiratingb. Breech-loading, plastic, cartridge-type, aspiratingc . Breech-loading, plastic, cartridge-type, self-aspiratingd. Pressure syringe for periodontal ligament injection

2 ) Disposable syringe

3 ) Safety syrin ge

4 ) Computer controlled local anesthetic deliverysystems


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ADA Standards for Injection Syringes

1. They must be durable and able to withstand repeatedsterilization without damage

2. They should be capable of accepting a wide variety ofcartridges and needles from different manufacturers and

permit repeated use

3. They should be inexpensive, self-contained, lightweight

and simple to use with one hand

4. Provide aspiration so blood can be seen through the glasscartridge


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Breech-Loading, Metallic, Cartridge-Type,Aspirating Syringe

-breech loading implies thatthe dental cartridge isloaded from the side

-a needle is attached to the barrel of the syringe at theneedle adaptor

-the needle passes into the barrel and pierces thediaphragm of the localanesthetic cartridge


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Aspirating Syringe-the harpoon is a sharp tip attached to the piston and is

responsible for penetrating the thick silicone rubberstopper (bung) at the other end of the cartridge

- negative pressure is applied to the thumb ring by theadministrator, if blood enters the glass local anesthetic

cartridge (carpule) then the tip of the needle is insertedinto the lumen of a blood vessel


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Breech-Loading, Plastic,Cartridge-Type, Aspirating Syringe


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Self-Aspirating Syringes -incidence of positive aspiration is between 10-15% for some

injections-aspiration before injection of local anesthetic is accepted in

the practice of dentistry and is overlooked to a great extent


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-these syringes use the elasticity of the rubber diaphragmin the anesthetic cartridge to obtain the necessarynegative pressure for aspiration

- multiple aspirations are possible with very littleeffort due to a small metal projection that applies pressure to the rubber diaphragm when the thumbring is depressed negative pressure aspiration

-this type of aspiration is as reliable as using theharpoon to check for blood aspiration


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-Major factor for aspiration is the gauge of theneedle being used

-Most doctors using the harpoon-type syringe, retractthe thumb ring back too far and with excessive forcewhich frequently disengages the harpoon from the

silicone rubber stopper of the cartridge


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-1st generation self-aspirating syringes required a thumb diskwhich forced the operator to remove their index and middlefingers from the thumb ring to the thumb disk to aspirate

-2nd generation self-aspirating syringes have removed thisthumb disk

-Dentists only need to stop applying pressure to the thumbring for aspiration; aspiration becomes very easy to do


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Pressure Syringes-PDL (intraligamentary) injections make it possible to achieve single tooth pulpalanesthesia in the mandible when, in the past,complete IANB was necessary


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-pressure syringes can allow too easy of an administration oflocal anesthetic producing pain and post-operative discomfort

-pressure syringes are expensive > $200.00

-can shatter glass cartridge if too much pressure is applied too

quickly


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2000 psi Jet Syringes ($1,600)

-needle-less injection

-liquids forced through very small openings, called

jets, at very high pressure can penetrate skin or intactmucous membrane

-Syrijet is the most popular used today

-Syrijet holds any 1.8 ml cartridge of local anesthetic


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-Syrijet is calibrated to deliver .05 to .2 ml of solution at2000 psi; traditional syringes deliver 600 psi maximum

-primary use is to obtain topical anesthesia before using aneedle

-regional nerve blocks/supraperiosteal injections are stillnecessary

-topical anesthetics provide the same effect at a fraction of

the cost

-patients complain of soreness where the 2000 psi hit theirtissue


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Disposable Syringes Luer-Lok screw on needle Manual aspiration No cartridges

Definitely preferred when diphenhydramine isused as LA


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Safety Syringe

-Aspiration is possible

-some brands come with an autoclavable plunger and disposable self-contained

injection unit

-all dental safety syringes are made to be single use items


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-sliding the index and middle finger forward against thefront collar of the guard makes the needle safe by slidinga protective plastic sheath over the needle tip that locks into

place

-more expensive than reusable syringe units

-large disadvantage arises when it comes to re-injecting;complication ensues due to the needle tips newly acquired

safety coping


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CCLAD (Computer Controlled LocalAnesthetic Delivery) The Wand

-designed to improve ergonomics and precision of injectiontechnique

-foot activated delivery of solution using finger tip precision

-pen-like grasp offers increased tactile sensation-flow rates of solution delivery are computer controlled and remain

consis tent


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- operator is able to focus attention on the position of theneedle tip while the motor of the machine delivers local

anesthetic at a preprogrammed rate of flow


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-The Wand is less threatening to the patients visually

-allows two rates of delivery:1) Slow: .5 ml/minute2) Fast: 1.8 ml/minute

-releasing the foot rheo-stat will tell the machine toaspirate automatically; the aspiration cycle is

approximately 4.5 seconds


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THE NEEDLE


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Parts of Needle


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Important Factors Bevel Gauge

Length


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Problems Pain on insertion Breakage

Pain on withdrawal Injury


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CARTRIDGE

C t idg


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Cartridge

1.8 mL (United States) 2.2 mL (UK and Australia) should not be autoclaved stored at room temperature (21

C to 22 C (70 F to 72 F) should not soak in alcohol should not be exposed to

direct sunlight


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Problems Bubble in the cartridge Extruded stopper

Burning on injection Sticky stopper Corroded cap

Leakage during injection Broken cartridge


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Additional armamentarium Topical antiseptic Topical anesthetic

Applicator sticks Cotton gauze Hemostats


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armamentarium for LA.pptx