Spinal needles clogging

[PMROralBoards]

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I typically use 25g spinals for injections like si joints. For the past few months I’ve had to switch to 22g needles because they seem to get “clogged”. The only thing different with these vs some other injections is using contrast and then depo. Even with 22g, maybe 20% of the time I can’t inject the depo/lido/marcaine after getting the arthrogram. Our EMR comes up with an interaction warning between depo and contrast which doesn’t happen with dex and contrast.

Has anyone run into this or is it just me? Even pulling the needle out and trying to inject against air it can remain plugged.

Thanks for any advice

 

[GatorCHOMPions]

This was mentioned weeks/months back in another thread. Myself and others had the same issue. It's probably your batch of steroid. It seems to have happened less with the latest batch I have. I switched to 22G permanently for SIJ regardless.

 

[oneforfighting]

It’s the steroid. I’ve also switched to 22g for any injection requiring steroids.

 

[BobBarker]

I use 22g spinal always for si joints. Branded depo. No issues with that combo.

 

[manowar rules]

Can you re-stylet the needle and clear the blockage that way?

 

[Ducttape]

that doesnt solve the problem. once you clean out the needle and inject again, those same clumps of steroid plug the needle again.

 

[MitchLevi]

All SIJ is 22g for me, and Depo will clog even that needle if you buy generic.

 

[PMROralBoards]

Well this is annoying. Does kenalog do the same thing? I’ve never had issues before June.

 

[MitchLevi]

Two to three yrs ago I call the manufacturer and asked to speak to someone about this and they completely stonewalled me. Would not admit it was a problem, wouldn’t tell me if they’d had similar complaints.

 

[PinchandBurn]

I have seen this issue even without steroids. I think its the patients skin or dermis...

 

[SpineandWine]

Can you re-stylet the needle and clear the blockage that way?

Yes (you can clear with PFNS flush) but it’s a pain to have to inject more volume in TFESI just to unclog
I switched to 22G while my batch of depo sucked

I only use 22G for SI. Don’t want tendinitis in future if you use 25G

 

[drmamba]

Had this happen earlier this week. Depo with bupivacaine in a 22G for SIJ. Could not clear the obstruction even with needle removal and injecting air. Fortunately it's a 5-10 second needle placement so I just used a new 22G needle.

 

[DOctorJay]

This has been happening with my 25g needles I use for ultrasound procedures. I need to check if we are using a different depo Medrol manufacturer in office as opposed to procedure suite (no issues so far there).

 

[Snowmen96]

This has been happening with my 25g needles I use for ultrasound procedures. I need to check if we are using a different depo Medrol manufacturer in office as opposed to procedure suite (no issues so far there).

Personally, for US guided procedures, I use a syringe with only lidocaine so I can get some numbing before piercing sensitive structures (fascias, joint capsules, etc.) and then inject lidocaine in the target structure to see if it's intra-articular, etc. I then switch to a different syringe (without removing the needle from the patient) containing just corticosteroid. That way, I avoid incompatibilities and make sure all the corticosteroid is going where I want it too. Takes a few seconds longer at most.