Inadvertent disc injection with TFESI

[schmee90]

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accidentl disc injection with 92 yo patient today, 2nd one I've had as an attending read some literalture on it including IPSIS fact finder. Is anybody doing abx after the inejction for prevention. this guy is allergic to everything including pen, cephalsporins, dont want to give him clinda and give him C dif. talked to family and will watch him closely.

would love to hear any insights. Ive seen some other threads were it happened and people were like whatever and redirected the needle and thats it

 

[knoxdoc]

Happens from time to time. I have never given abx and have never had a complication. No worries.

 

[RoloTomassi]

Has happened a handful of times. First few times I chased the contrast with some clinda or gent, like 0.25 ml. Then I just stopped doing anything, no complications.

 

[Taus]

Several times over the years.
I gave PO keflex or bactrim if allergy. One of them was in the Asc and I gave Iv abx. I now keep IM abx in the office for scs and kypho… would prob give it if/when happens again.

probably unnecessary and perhaps the risk of side effects from the antibiotic is higher than the risk of disc infection.

That said, for a tfesi I’m not scrubbed, gowned, masked, double needle etc like I would have done for a diagnostic discogram back in the day. Given that I would do all that when I accessed disc on purpose, felt odd to do nothing when I accessed disc inadvertently with just sterile gloves on and chloroprep on skin.

 

[schmee90]

for abx how long duration i saw some case repors/review articles say 3 days.

 

[SSdoc33]

"like whatever and redirected the needle and thats it"

this is the way. pretend it never happened and dont overthink it. there is a risk of infection in every procedure we do, and that is on the consent. ive never had a discitis after, what 30, 40K injections?

also, abandon the dumb infraneural approach if you are doing it. its more painful, greater chance of spearing the nerve, and more likely to be intra-discal

 

[Gauss]

"like whatever and redirected the needle and thats it"

this is the way. pretend it never happened and dont overthink it. there is a risk of infection in every procedure we do, and that is on the consent. ive never had a discitis after, what 30, 40K injections?

also, abandon the dumb infraneural approach if you are doing it. its more painful, greater chance of spearing the nerve, and more likely to be intra-discal

 

[Centurion38]

This is going to happen occasionally at L5/S1 with severe DDD and monster facets.

If it's not happening you probably work an Ortho Chop Shop fusing healthy 45 yo's with mild DDD

It's called "Dino-Spine"

I bill the discogram on the sly, ABN is size 2 font on the consent