骨科手术中的安全注射器和防针刺伤装置。

Safety syringes and anti-needlestick devices in orthopaedic surgery.

机构信息

Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA.

出版信息

J Bone Joint Surg Am. 2011 Sep 7;93(17):1641-9. doi: 10.2106/JBJS.J.01255.

DOI:10.2106/JBJS.J.01255

PMID:21915580

Abstract

BACKGROUND

The American Academy of Orthopaedic Surgery (AAOS), The Joint Commission, the Occupational Safety and Health Administration (OSHA), and the Needlestick Safety and Prevention Act encourage the integration of safety-engineered devices to prevent needlestick injuries to health-care workers and patients. We hypothesized that safety syringes and needles could be used in outpatient orthopaedic injection and aspiration procedures.

METHODS

The study investigated the orthopaedic uses and procedural idiosyncrasies of safety-engineered devices, including (1) four safety needles (Eclipse, SafetyGlide, SurGuard, and Magellan), (2) a mechanical safety syringe (RPD), (3) two automatic retractable syringes (Integra, VanishPoint), (4) three manual retractable syringes (Procedur-SF, Baksnap, Invirosnap), and (5) three shielded syringes (Safety-Lok, Monoject, and Digitally Activated Shielded [DAS] Syringe). The devices were first tested ex vivo, and then 1300 devices were used for 425 subjects undergoing outpatient arthrocentesis, intra-articular injections, local anesthesia, aspiration biopsy, and ultrasound-guided procedures.

RESULTS

During the clinical observation, there were no accidental needlesticks (0 needlesticks per 1300 devices). Safety needles could be successfully used on a Luer syringe but were limited to ≤1.5 in (≤3.81 cm) in length and the shield could interfere with sonography. The mechanical safety syringes functioned well in all orthopaedic procedures. Automatic retractable syringes were too small for arthrocentesis of the knee, and the plunger blew out and prematurely collapsed with high-pressure injections. The manual retractable syringes and shielded syringes could be used with conventional needles for most orthopaedic procedures.

CONCLUSIONS

The most effective and reliable safety devices for orthopaedic syringe procedures are shielded safety needles, mechanical syringes, manual retractable syringes, and shielded syringes, but not automatic retractable syringes. Even when adopting safety-engineered devices for an orthopaedic clinic, conventional syringes larger than 20 mL and conventional needles longer than 1.5 in (3.8 cm) are necessary.

摘要

背景

美国骨科外科学会（AAOS）、联合委员会、职业安全与健康管理局（OSHA）和《针刺安全与预防法案》鼓励整合安全工程设备，以防止医护人员和患者发生针刺伤。我们假设安全注射器和针头可用于门诊骨科注射和抽吸程序。

方法

该研究调查了安全工程设备在骨科中的使用情况和特殊操作方法，包括（1）四种安全针头（Eclipse、SafetyGlide、SurGuard 和 Magellan），（2）一种机械安全注射器（RPD），（3）两种自动回缩注射器（Integra、VanishPoint），（4）三种手动回缩注射器（Procedur-SF、Baksnap、Invirosnap），以及（5）三种带护套的注射器（Safety-Lok、Monoject 和 Digitally Activated Shielded [DAS] Syringe）。首先对这些设备进行了离体测试，然后对 425 名接受门诊关节穿刺术、关节内注射、局部麻醉、抽吸活检和超声引导操作的患者使用了 1300 个设备。

结果

在临床观察期间，没有发生意外针刺伤（每 1300 个设备中无 1 例针刺伤）。安全针头可以成功地用于鲁尔注射器，但长度限于≤1.5 英寸（≤3.81 厘米），且护套可能会干扰超声检查。机械安全注射器在所有骨科手术中都能正常工作。自动回缩注射器对于膝关节的关节穿刺术来说太小了，而且随着高压注射，柱塞会弹出并过早塌陷。手动回缩注射器和带护套的注射器可以与常规针头一起用于大多数骨科手术。