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TPI- can you put following in same syringe
Started by SpineandWine
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Why do you care if it precipitates? Depo is already particulate. And you're injecting in muscle so why are you worried? That's not an uncommon IM cocktail done by PCP/ER/urgent care.
Why are you putting anything more than LA for a TPI?
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Normally I don’t- just a question that came up.
She was adamant in not mixing ketorolac and depomedrol for IM.
Rarely do I do this. I was not able to come in for a supervised TPI, as I was on other side of hospital doing a procedure. I just said instead to give IM ketorolac and depo at one site while I was away in the buttocks. She stated you can’t mix the two for IM.
My opinion is it doesn’t matter but wanted your thoughts
She was adamant in not mixing ketorolac and depomedrol for IM.
Rarely do I do this. I was not able to come in for a supervised TPI, as I was on other side of hospital doing a procedure. I just said instead to give IM ketorolac and depo at one site while I was away in the buttocks. She stated you can’t mix the two for IM.
My opinion is it doesn’t matter but wanted your thoughts
Does she have literature that supports her assertion? My guess is she was taught that by an older RN who was taught by another RN who was taught by another RN....
That being said, it doesn't matter if it's IM and depo is already a particulate.
And I just to be clear, when you say "nurse" and "TPI", do you mean an NP doing a TPI or an RN doing an IM injection? I'm pretty sure RNs cannot do TPI.
That being said, it doesn't matter if it's IM and depo is already a particulate.
And I just to be clear, when you say "nurse" and "TPI", do you mean an NP doing a TPI or an RN doing an IM injection? I'm pretty sure RNs cannot do TPI.
It’s a recent NP (recent graduate) doing IM injection - saying this is what she was taught when she worked in ED as a nurse. She was making argument that it’s her license on line….
Agree, made no sense but she felt uncomfortable so didn’t do it
Agree, made no sense but she felt uncomfortable so didn’t do it
As long as one of the trigger points isn't inside the patient's veins, it's meaningless if it precipitates
FYI, you can dilute your bupi down to 0.125% at least and still get an anesthetic effect for trigger points. Been doing it for years, saves tons of local. I like a lot of volume, 20 mL would be typical for a set of bilateral cervical trap injections along the fascia planes. I use 250 mL bags for economical saline.
You can also use carpenter nails as a touhy. Flexible straw as extension tubing. Car headlights can substitute in for a c-arm in a pinch.
Thanks to supply shortages, the US is now an austere practice environment. Good call on the flexible straw!
Id actually love to use less sh@t during procedures. Just so much waste, plastic, etc....
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... which of course you will only use for one patient...
"Even if a single-dose or single-use vial appears to contain multiple doses or contains more medication than is needed for a single patient, that vial should not be used for more than one patient nor stored for future use on the same patient."
Questions about Single-dose/Single-use Vials | Injection Safety | CDC
Can single-dose or single-use vials be used for more than one patient? And other questions about the use of single-dose medication vials.
www.cdc.gov
"Multi-dose vials should be dedicated to a single patient whenever possible."
Questions about Multi-dose vials | Injection Safety | CDC
Can multi-dose vials be used for more than one patient? And other questions about the use of multi-dose medication vials.
www.cdc.gov
... which of course you will only use for one patient...
"Even if a single-dose or single-use vial appears to contain multiple doses or contains more medication than is needed for a single patient, that vial should not be used for more than one patient nor stored for future use on the same patient."
Fyi, every saline bag is considered a single-dose.Questions about Single-dose/Single-use Vials | Injection Safety | CDC
Can single-dose or single-use vials be used for more than one patient? And other questions about the use of single-dose medication vials.
"Multi-dose vials should be dedicated to a single patient whenever possible."
Questions about Multi-dose vials | Injection Safety | CDC
Can multi-dose vials be used for more than one patient? And other questions about the use of multi-dose medication vials.
I'm aware of the CDC's recommendations.
Do any of you throw out an entire 50 mL bottle of Omni after using it for one injection? Of course you do.
I recognize that these CDC recommendations only came about due to reacting to the infections from New England compounding company.
The CDC rules on MDV are not based on science but based on the political art of trying to look you’re doing something. (After the New England compounding fiasco)
It was more than just NECC. 2 separate issues - contaminated drugs and cross contamination by injection practices.
Cross contamination cases predated NECC disaster by quite a few years.
There was also a different compounding pharmacy complications, at least 13 of them, between 2001 and 2013.
In terms of cross contamination, there were several cases including 3 in a pain clinic in Arizona that lead to MRSA.
Cross contamination cases predated NECC disaster by quite a few years.
There was also a different compounding pharmacy complications, at least 13 of them, between 2001 and 2013.
In terms of cross contamination, there were several cases including 3 in a pain clinic in Arizona that lead to MRSA.
Dirty medical needles put tens of thousands at risk in USA
In an age of superbugs, patients still face a threat that should have died with the advent of the disposable syringe.
www.usatoday.com
One needle policy started in 2007...
Reference ?
Don't use the same syringe and a lot of those go away.It was more than just NECC. 2 separate issues - contaminated drugs and cross contamination by injection practices.
Cross contamination cases predated NECC disaster by quite a few years.
There was also a different compounding pharmacy complications, at least 13 of them, between 2001 and 2013.
In terms of cross contamination, there were several cases including 3 in a pain clinic in Arizona that lead to MRSA.
Dirty medical needles put tens of thousands at risk in USA
In an age of superbugs, patients still face a threat that should have died with the advent of the disposable syringe.www.usatoday.com
The ortho and pain clinic--probably didn't alcohol wipe between punctures or kept vials way too long
Sorry, but we're not in a situation of medication excess in 2023.
The risk is virtually zero.
Many thousands of procedures in our practice from 20+ doctors and an equal number of midlevels.
Yall are foolishly contributing to supply shortages and rising costs.
The risk is virtually zero.
Many thousands of procedures in our practice from 20+ doctors and an equal number of midlevels.
Yall are foolishly contributing to supply shortages and rising costs.
I don’t currently do this. But I would defend your position.
Noted...When I throw an MRSA wound in the ICU and I get sued you're gonna get a well-written PM from our practice attorney asking for help!
Isolation Precautions | Guidelines Library | Infection Control | CDC
Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007)
www.cdc.gov
Safe Injection Practices to Prevent Transmission of Infections to Patients | Injection Safety | CDC
Guidelines for safe injection practices.
www.cdc.gov
===
the "original" compounding pharmacy mess occurred in 2002.
Exophiala infection from contaminated injectable steroids prepared by a compounding pharmacy--United States, July-November 2002 - PubMed
In the United States, pharmacists compound medications to meet unique patient drug requirements or to prepare drug products that are not available commercially. In September 2002, the North Carolina Division of Public Health (NCDPH) was notified of two cases of meningitis caused by a rare fungus...
pubmed.ncbi.nlm.nih.gov
===
I posted this in 2013.
to rolo's comment - no it was using single dose vial for 4 separate patients, 3 of whom got MRSA.
it is appropriate to access multi dose vials repeatedly. generally they contain an antibacterial preservative.
you cannot say the same about reusing or reaccessing single dose vials, since pandemic practices are ending (a lot of practices were "allowed" during the pandemic").
If you sterilize it and draw up all the meds back to back to back and don't contaminate your needle it's fine.
The risk of that becoming infectious is dramatically less than whatever procedure you're about to do.
At my old practice we'd have a bottle of Omni in each of two fluoro rooms. Each would see ~25+ dye cases per day, with two different docs drawing from the SDV bottle with a 20g needle. The top would get alcohol wiped by the tech between cases. The bottle would be discarded at the end of the day. Despite being *kind of* uncomfortable with this barely adequate setup, no infections in 10+ years.
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Don’t put corticosteroids in your TPI
It’s not an inflammatory condition. Don’t Bombard people with steroids
Learn to do US guided plane injections also. You’ll get better results and dispersion of injectate
It’s not an inflammatory condition. Don’t Bombard people with steroids
Learn to do US guided plane injections also. You’ll get better results and dispersion of injectate
Systematic review
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Agree with this. Steroids have no role in TPI.
they are for noctors who can’t do a proper TPI, so they just do an IM steroid injection, which they call a TPI.
