Procedure minutiae

[bubaghanush]

---

Members do not see this ad.

Curious about how others view the minor practices below.

1) Do you reconstitute for particulate steroid?
I'm used to squirting the normal saline back in the vial a couple of times to get the Depomedrol off the container surface.

2) Do you swab your vial caps with alcohol?
I do for ESI.

3) Do you drape for medial branch blocks?
I do. It is faster since we switched to a cutout drape rather than four sticky drapes, but wondering if necessary at all if prep is wide.

4) Do you use bandaids or Tegaderm?
I generally do for 22 gauge needles but not 25 gauge needles. I'm wondering if I should just skip and only use band aid if obvious bleeding. Tegaderms are excessive but our staff is used to opening them for our group so sometimes use these.

5) Do you numb with lidocaine at skin only, or also numb deeper intramuscular?
I do skin only, but for RFTC I will numb deeper intramuscular.

 

[FacetiousJoint]

1) i do the same, usually i will draw up the local/NS into syringe then squirt a little into the vial and suck it all out

2) do not swab

3) we still drape for MBB. wish we had the plastic cutout drape, but our kits come with the 4 sticky blue ones

4) bandaids for everybody, doesnt matter if its tuohy or 25 gauge

5) depends on the patient and gauge of the needle. 25 gauge procedures dont numb generally, but may squirt some local when pulling the needle out
22g and above I numb with the 30gauge hypodermic in the kit

 

[Taus]

Curious about how others view the minor practices below.

1) Do you reconstitute for particulate steroid?
I'm used to squirting the normal saline back in the vial a couple of times to get the Depomedrol off the container surface.

Shake vial and draw

2) Do you swab your vial caps with alcohol?
I do for ESI.

Yes, all

3) Do you drape for medial branch blocks?
I do. It is faster since we switched to a cutout drape rather than four sticky drapes, but wondering if necessary at all if prep is wide.

Takes 1sec to throw on a cheap federated drape. Rip open larger hole or just go through it for bilat or multi needle(mbb/rfa)

4) Do you use bandaids or Tegaderm?
I generally do for 22 gauge needles but not 25 gauge needles. I'm wondering if I should just skip and only use band aid if obvious bleeding. Tegaderms are excessive but our staff is used to opening them for our group so sometimes use these.

Bandaid. If multi-needle (ie mbb/rfa): fold 4x4 w tape

5) Do you numb with lidocaine at skin only, or also numb deeper intramuscular?
I do skin only, but for RFTC I will numb deeper intramuscular.

Both, bury local needle quickly, then inject as withdraw to cover both for 22g or larger needle

 

[GoBeers]

not draping saves a lot of time

 

[JFS]

Curious about how others view the minor practices below.

1) Do you reconstitute for particulate steroid?
I'm used to squirting the normal saline back in the vial a couple of times to get the Depomedrol off the container surface.

2) Do you swab your vial caps with alcohol?
I do for ESI.

3) Do you drape for medial branch blocks?
I do. It is faster since we switched to a cutout drape rather than four sticky drapes, but wondering if necessary at all if prep is wide.

4) Do you use bandaids or Tegaderm?
I generally do for 22 gauge needles but not 25 gauge needles. I'm wondering if I should just skip and only use band aid if obvious bleeding. Tegaderms are excessive but our staff is used to opening them for our group so sometimes use these.

5) Do you numb with lidocaine at skin only, or also numb deeper intramuscular?
I do skin only, but for RFTC I will numb deeper intramuscular.

1. Shake vial or aspirate some into syringe and reinject into vial to shake it up

2. Not for single use vials as long as didn't touch center

3. For lumbar MBB rarely just drape on bottom if close to edge of field. More likely to drape cervical as hair can get in the way.

4. Never tegaderm for basic procedures/RFA. Bandaids 50% of the time.

5. I never numb for 22 and 25G. Tried a few variations but the numbing by and large was the most painful step, even numbing on the way out after procedure. Just be fast/decisive in your poke and be fast but accurate in your procedure. Patients seem to appreciate speed / talking to them through procedure more than anything.

 

[Ronin1]

Evidence is marginal but I still Swab for legal documentation

https://cdn.ymaws.com/www.ipsismed.org/resource/resmgr/factfinder/25/03-FF-Vial_Swabbing.pdf

 

[giddyup]

Curious about how others view the minor practices below.

1) Do you reconstitute for particulate steroid?
I'm used to squirting the normal saline back in the vial a couple of times to get the Depomedrol off the container surface.

2) Do you swab your vial caps with alcohol?
I do for ESI.

3) Do you drape for medial branch blocks?
I do. It is faster since we switched to a cutout drape rather than four sticky drapes, but wondering if necessary at all if prep is wide.

4) Do you use bandaids or Tegaderm?
I generally do for 22 gauge needles but not 25 gauge needles. I'm wondering if I should just skip and only use band aid if obvious bleeding. Tegaderms are excessive but our staff is used to opening them for our group so sometimes use these.

5) Do you numb with lidocaine at skin only, or also numb deeper intramuscular?
I do skin only, but for RFTC I will numb deeper intramuscular.

1. Yes
2. Only if it’s a reusable vial and I’ve used it, if I just popped the cap off I don’t but maybe should?
3. Yes, fenestrated/cutout drape
4. Bandaids
5. I don’t numb for lots of stuff. I think it hurts worse than the actual needle stick. I will numb for 20g or larger, and I will numb skin the subq a lil bit

 

[pastafan]

not draping saves a lot of time

Not prepping would save even more time...

 

[SSdoc33]

no drapes

Waste of blue towels, paper, time

Tegaderm? No way

You are spending way too much time in the OR. These should be very quick and minimally invasive procedures. Don’t waste time or money making them more complicated.

Only swab if you reuse or drop a vial. If you pop the top you don’t need to swab

 

[GoBeers]

Not prepping would save even more time...

have the nurse prep.

in all seriousness, for peripheral extremities, mbb or tfesi, there is no need to drape. just keep your arms up or rest your elbows on their glutes/thighs if you have to. the needle should never touch the patient's body other then point of entry.

 

[PMROralBoards]

Nurses at my ASC would have a stroke if they saw anyone doing procedures without towels

 

[GoBeers]

Nurses at my ASC would have a stroke if they saw anyone doing procedures without towels

nurses will be nurses

 

[BoardingDoc]

1: no. Shake and draw
2: yes
3: I don't drape for nearly any office procedure. Just prep well and don't touch crap that isn't prepped. Not hard.
4: bandaid if needed. Basically all 25g injections don't wind up needing a bandage of any kind.
5: lido for anything bigger than a 22g. Otherwise no.

 

[Ronin1]

no drapes

Waste of blue towels, paper, time

Tegaderm? No way

You are spending way too much time in the OR. These should be very quick and minimally invasive procedures. Don’t waste time or money making them more complicated.

Only swab if you reuse or drop a vial. If you pop the top you don’t need to swab

Actually it’s not sterile under the pop top
…..

 

[SSdoc33]

Nurses at my ASC would have a stroke if they saw anyone doing procedures without towels

the lion doesnt concern himself with the opinion of of sheep
-george RR martin

it is a gigantic waste of resources to throw 4 towels on a patient for a simple SIJ, TFESI or MBB.

 

[SSdoc33]

Actually it’s not sterile under the pop top
…..

i have heard that, but id argue that adding the swab may actually introduce bacteria

 

[RoloTomassi]

I do everything like Taus.

Another question--do y'all put stylets back in when you move needles to the other side?

 

[SSdoc33]

Another question--do y'all put stylets back in when you move needles to the other side?

yeah