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Pulsator Syringe...A Note of Caution...

Discussion in 'Pain Medicine' started by algosdoc, Jun 17, 2008.

  1. algosdoc

    algosdoc algosdoc
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    The Pulsator syringe for epidural injection has a plunger that can be pulled back beyond a stop tab, and if the operator is unaware the plunger is so engaged, can experience "bounce" of the plunger when advancing with no loss of resistance. The needle can be driven all the way across the spinal canal (don't ask me how I know....fortunately mine was lumbar and other than a transient spinal headache, no foul). If the needle is advanced with the plunger in this position and if "danger view" fluoroscopy is not used (lateral in the thoracic and lumbar, Pullitz line or lateral in the cervical), then significant damage to the cord, dura, spinal nerves, annulus fibrosis can occur.
    On the other hand, glass syringes, even when pre-wetted, can bind at the most inopportune moments..
    Moral of the story: use lateral view fluoro guidance (or modification) for advancement of an interlaminar needle, otherwise it is just a blind epidural stick.
     
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  3. lobelsteve

    lobelsteve SDN Lifetime Donor
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    Thank you for the update. I've tried Epilor silicone and glass. My preference is a plain old 10cc plastic syringe with NSS. I like to get off the lamina and go lateral to watch advancement. LOR, shoot contrast live. Take a picture. Go AP and more contrast live, take a picture. Test dose. Cocktail.

    Preference is a funny thing, I have friends who swear by glass and others with the silicone. Probably a lot of superstition, but a syringe design flaw is another issue entirely.
     
  4. Mister Mxyzptlk

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    This is not a defect, it's an opportunity. I have billed for 6 vertebral and 3 disk biopsies using these syringes.

    Oh, and one prostate biopsy.
     
  5. PMR 4 MSK

    PMR 4 MSK Large Member
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    :laugh::laugh::laugh::laugh::laugh:

    When you go back to AP after lateral, are you just watching for laterality (lateralness? laterosity?) of the spread, or more for watching for vascular uptake? I don't usually do AP again.
     
  6. lobelsteve

    lobelsteve SDN Lifetime Donor
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    Just want to know where the medicine is going in a 3D sort of way. Especially when the symtpoms correlate with the imaging- I want the flow of Celestone (or whatever) to blanket the pathology.
     

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