Eldor needle's advantage over the needle-through-needle technique.
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Anesthesia, Epidural↗
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Pencil-point needles and combined spinal epidural block. Why needle through needle?
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Anesthesia, Epidural↗
Needle length and incidence of local reactions to immunization. Needle gauge is more important than needle length.
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Drug Eruptions↗
Relations between Scots pine needle element concentrations and decreased needle longevity along pollution gradients.
Scots pine (Pinus sylvestris L.) shoots were sampled along transects near one urban pollution source and two smelters. Needle Mg, P and K concentrations decreased from the second to the fourth age class linearly with needle survival along the urban pollution gradient. Still, over 80% of the average concentration of these nutrients remained in the fourth needle age class. Decreased needle longevity was closely related to the increased heavy metal concentrations near the smelters. Near the urban pollution source, it was related to the increased annual needle mass and the increased needle nutrient concentrations. Decreased Mn accumulation along with needle age was detected near all pollution sources. Leaching of Mn from needles and especially from soil as a cause of decreased needle concentrations is discussed.
Air Pollutants↗
Comparison of a needle-free high-pressure injection system with needle-tipped injection of intracavernosal alprostadil for erectile dysfunction.
Patients identified from hospital records as using alprostadil injections for erectile dysfunction were invited to take part in this open crossover study. On alternate weeks eight patients were given intracavernosal needle injections and transdermal needle-free injection of alprostadil in a randomized order. Efficacy of injection and associated pain were assessed and compared for the two methods. Pain produced during injection was significantly greater with the needle-free system than with the needle-tipped injection whilst efficacy was significantly less. Bruising was reported in all except one patient following needle-free injection only. Patient ratings of the needle-free injector were significantly lower than ratings for needle-tipped alprostadil delivery and when asked to express a preference, every patient chose the needle-tipped injection over the needle-free device.
Adult↗
Two-needle calculation of recirculation compared with the standard three-needle method.
A two-needle method for calculating recirculation was compared with the standard three-needle method, substituting the standard phlebotomy of a remote vessel during dialysis with blood obtained from the dialyzer inlet needle 15 minutes after the termination of dialysis. Twenty patients were studied prospectively. There was no significant difference between corrected blood flow calculated with the standard and two-needle methods. The BUN obtained from the inlet line needle 15 minutes after conclusion of the treatment did not differ significantly from the BUN concentration in the specimen from a contralateral arm drawn five minutes before termination of dialysis. Recirculation calculated by the two-needle method correlated well with the results obtained with the standard three-needle method. The two-needle method provides a convenient alternative to the standard three-needle method of determining recirculation.
Aged↗
Discarded needles do not increase soon after the opening of a needle exchange program.
This study examines the effect of a Needle Exchange Program (NEP) on the quantity and geographic distribution of discarded needles on the streets of Baltimore, Maryland, and presents methods to survey discarded needles in the community. A random sample of 32 city blocks located within high-drug-use census tracts, stratified by east and west sides of the city and by proximity to the NEP, was selected for survey. Three teams surveyed the number of needles and the number of drug vials and unbroken glass bottles ("trash") to control for practice effects. Surveillance was conducted prior to initiation of the NEP in August 1994 and 1 and 2 months thereafter. Over the three study periods, the absolute count of discarded needles was 106, 130, and 128, respectively; the number of vials and bottles was 3,048, 3,825, and 3,796, respectively. The initial nonstatistically significant increase in needles (mean change = 0.38, 95% confidence interval (CI) -0.18 to 0.93) was offset by accounting for background trash. Regression models fitted with the generalized estimating equation method, which accounted for within-block correlation over time, showed no significant increase in the number of needles after adjustment for trash during the first 2 months of the NEP's operation. These data suggest that the initiation of NEPs does not result in an increase in the number of discarded needles on the street.
Baltimore↗
Lack of tumor seeding of hepatocellular carcinoma after percutaneous needle biopsy using coaxial cutting needle technique.
OBJECTIVE: The objective of our study was to determine the incidence of tumor seeding after biopsy of hepatocellular carcinoma (HCC) using a coaxial cutting needle technique. Seeding along the needle track is a dreaded complication of percutaneous biopsy in patients with HCC, particularly in potential liver transplant recipients. Reported seeding rates range from 0.6% to 5.1% using various biopsy techniques. To our knowledge, the rate of seeding using a coaxial cutting needle technique has not been reported. MATERIALS AND METHODS: Retrospective review identified 128 patients with imaging-guided percutaneous liver biopsies positive for HCC. A coaxial cutting needle technique was uniformly used with a 17-gauge introducer and 18-gauge biopsy needle. Radiology and clinical reports were reviewed, and findings at clinical and imaging follow-up were assessed. RESULTS: During the 6-year study period, 1,012 liver mass biopsies were performed, with 128 positive for HCC (100 men and 28 women; average age, 58.4 years). One hundred one patients had more than 30 days of clinical or imaging follow-up (or both) after biopsy (mean, 410 days; range, 33-1,989 days) and constituted the study population. The remaining 27 were excluded because of inadequate follow-up. No suspected or confirmed tumor seeding on imaging, physical examination, or laparotomy was identified. CONCLUSION: We found no tumor seeding after percutaneous biopsy of HCC using a coaxial cutting needle technique. This rate, 0%, is lower than those reported with other techniques. The use of a needle introducer that remains in position during multiple cutting needle passes protects normal tissue along the track and may reduce seeding. This has particular importance for patients with stage I-II HCC, for whom liver transplantation may be curative.
Biopsy, Needle↗
[Is the Tru-Cut needle more efficient than the fine needle in the diagnosis of hepatic lesions? Comparative study of 45 echography-guided punctures].
A comparison of diagnostic efficiency of fine needle biopsy (22 G) versus coarse needle biopsy (Tru-Cut 14 G) was performed on ultrasound-guided liver biopsies in 45 patients. Diagnosis was established through clinical, paraclinical and pathologic features. For each patient pathologic examination of both fine needle biopsy (cytology and histology) and coarse needle biopsy (histology) were performed by a pathologist unaware of any clinical data. Of 36 malignant tumors, diagnosis of malignancy was made in 83 percent of the cases by fine needle biopsy and in 81 percent of the cases by Tru-Cut biopsy, and distinction between primary and secondary cancer, in 83 and 86 percent of cases respectively. Specificity was 100 percent with both techniques. Of 9 benign lesions, the 6 focalized fatty infiltrations were diagnosed by both fine and coarse needle biopsies. As fine needle biopsy is less invasive than coarse needle biopsy and gave equally satisfying results, we suggest that it should be used preferentially in the diagnosis of focalized liver lesions.
Biopsy, Needle↗
Past, present, and future for surgical needles and needle holders.
During the last two decades, major advances in surgical needle and needle holder technology have markedly improved surgical wound repair. These advances include quantitative tests for surgical needle and needle holders performance, high nickel maraging stainless steels, compound curved needles, needle sharpening methods, laser-drilled holes for swages, needle:suture ratios of 1:1, and the atraumatic needle holder.
Animals↗
Effect of changing needle disposal systems on needle puncture injuries.
Accidental needle puncture injuries continue to pose a hazard to hospital workers. In order to reduce the number of such injuries in our hospital, needle disposal procedures were revised to discourage recapping and prevent bending or clipping of needles before discard. Collapsible cardboard boxes were replaced with impervious containers. An educational program accompanied these changes. We compared reports of needlestick injuries before and after the change of procedure, for three parallel 9-month periods. During the 27-month study, injuries occurred during administration of medication (22%), or recapping of used needles (16%), from needles protruding through (10%) or out of the "mouth" (9%) of the container, from needles left in the patient's environment (10%), or those left on procedure trays (7%). Seven percent were the result of being stuck by someone else, usually in the operating room. The mechanism of injury for 19% was not described. Altering the disposal procedures did not change the number or anatomic site of injuries, nor the risk of injury among the various job categories. A reduction in the rate of sticks from needles protruding through the container (1.3 vs 0.3/mo, p less than or equal to 0.005) was the only difference observed. Changing the needle receptacle changed the type but not the overall number of injuries. The education program had little effect on the number and types of injuries. These data point to the need for developing innovative approaches for eliciting changes in behavior of health care personnel.
Accidents, Occupational↗
Anchoring of the internal jugular vein with a pilot needle to facilitate its puncture with a wide bore needle: a randomised, prospective, clinical study.
In this prospective, randomised study, consented adult patients of both genders were divided into two groups. In group 1 (n = 79) patients, during internal jugular vein cannulation, the pilot needle was removed before the wide bore needle (18G) puncture. In group 2 (n = 78) patients, the internal jugular vein was anchored by leaving the pilot needle in place during wide bore needle puncture. In demographically similar groups, the first attempt success rate improved from 64% in group 1 to 81% in group 2 (p < 0.05). Internal jugular vein puncture was more frequently detected at the entry of the needle with anchoring (group 2: 78%) than without (group 1: 53%); p < 0.05. Ultrasonography of a further 30 internal jugular vein punctures in each group demonstrated that the anchoring manoeuvre (group 2b) significantly (p < 0.05) prevented an indenting effect of the puncture needle, with a higher vertical to horizontal diameter ratio of the internal jugular vein when there was anchoring (0.97; SD 0.004) than without pilot needle anchoring (0.65; SD 0.008). In conclusion, when using surface landmarks, anchoring of the internal jugular vein with the pilot needle facilitated its puncture.
Adult↗
A systematic review to ascertain whether the standard needle is more effective than a longer or wider needle in reducing the incidence of local reaction in children receiving primary immunization.
CONTEXT: Millions of doses of vaccines are given to children within the United Kingdom (UK) each year, yet there is conflicting national guidance on the length of needle to use. Prefilled syringes come supplied with 25 Gauge 16 millimetres long needles. OBJECTIVES: A systematic review was completed to answer the clinical question of whether the standard needle is more effective than a longer and/or wider needle in reducing local reactions in children receiving primary immunizations. METHODS DATA SOURCES: A comprehensive search strategy, including searching of electronic databases, hand searching, reference/citation searching, contacting researchers in the field and searching for unpublished literature. STUDY SELECTION: Selection of studies was guided by the clinical question, the inclusion and exclusion criteria being applied by two people independently. Study quality assessment: An established quality checklist was used. Critical analysis of the quality of the components of the studies is included in the discussion. DATA EXTRACTION: Two people independently applied a data extraction form, designed for the study. RESULTS: (1). Rev Man (a Windows-based software package used by the Cochrane Collaboration) was used to perform a meta-analysis on the binary results of two small studies using Relative Risk as the summary statistic 16 mm vs. 25 mm needle. (2). The pooled Relative Risk for redness was 2.52 [95% confidence interval (CI) fixed 1.70-3.72] P < 0.00001. (3). The pooled Relative Risk for swelling was 2.31 (95% CI fixed 1.55-3.43) P < 0.00003. CONCLUSION: (1). The results are statistically very highly significant and favour the use of the 25 millimetre long needle. (2). No studies were identified to separate the effect of the gauge of the needle used, but the discussion shows that needle length is the most important variable. (3). The results should be incorporated into any future guidelines on vaccine administration in the UK.
Equipment Design↗
[Comparison between copper needle insertion and stainless steel needle insertion into rabbit ear central veins].
OBJECTIVE: The clinical application of copper needle insertion has been proceeded satisfactorily for peripheral vascular disorders. This work was to study the mechanism of the copper needle insertion on a pathological basis. METHODS: Sixty rabbits were used in the experiments. The copper needle or the stainless steel needle was inserted into the ear central vein of the animal. Then the specimens of the central vein including its surrounding tissue were taken for light and electron microscopic examinations. RESULTS: At 7 days after copper needle insertion, acute inflammation reaction of the venous wall and vascular thrombosis were revealed in the specimens. At 14 days, giant cells granuloma and destruction of the venous wall were seen. After 28 days to 2 months, granuloma and the residual destroyed venous wall were gradually absorbed and fibrosis resulted. The vascular inflammation and thrombosis caused by stainless steel needle insertion was slight and slow. CONCLUSION: Copper needle treatment for vascular disorders is superior to the stainless steel needle.
Animals↗
[A case of pulmonary metastasis from carcinosarcoma of uterus with subcutaneous implantation of tumor cells along the needle tract after percutaneous needle biopsy of lung].
A 68-year-old female who had undergone total hysterectomy for carcinosarcoma five months previously was noted to have a solitary nodular shadow in the right lung on chest X-ray. Percutaneous needle biopsy of the lung was performed via the right anterior chest wall, and the histologic findings showed metastasis from carcinosarcoma of uterus. Two months after needle biopsy, a chest wall mass appeared of the site of puncture of the lung needle biopsy. The mass was resected to relieve the chest wall pain and the specimen showed carcinosarcoma of uterus histologically. We consider that tumor cells were implanted to the chest wall along the needle tract after percutaneous needle biopsy of the lung. The postoperative chest computed tomogram showed the route of tumor implantation from the metastasis of right lung into the right chest wall. Dissemination and chest wall implantation of malignant cells after percutaneous lung needle biopsy have been rarely reported. However there are no reports of tumor implantation of sarcoma. The possibility of implantation of tumor cells along the needle tract after percutaneous lung needle biopsy should be carefully considered in cases of carcinosarcoma.
Aged↗
Measurement of intracompartmental pressure: a comparison of the slit catheter, side-ported needle, and simple needle.
An experimental model of acute compartment syndrome involving the anterolateral compartment of the hindlimb in dogs was used to compare three methods of measurement of intracompartmental pressure: the simple-needle technique, use of the slit catheter, and use of the side-ported needle. No statistical difference was found between the values obtained with the slit catheter and those obtained with the side-ported needle; the mean difference was 1.4 millimeters of mercury throughout the range of compartment pressures that were measured. The side-ported needle appeared to be as accurate as the slit catheter for the measurement of compartment pressures (p = 0.355, 1-beta = 0.9). The values obtained with use of the simple needle were consistently higher than those obtained with the other two methods (p < 0.001): an average of 18.3 millimeters of mercury higher than the values measured with the slit catheter and 19.3 millimeters of mercury higher than those measured with the side-ported needle. Clinically, the side-ported needle or the slit catheter can be used to obtain accurate measurements of compartment pressure. Use of the simple 18-gauge needle is not recommended for this purpose.
Acute Disease↗
Tree- and needle-age-dependent variations in antioxidants and photoprotective pigments in Norway spruce needles at the alpine timberline.
To cope with environmental stress, plants are equipped with antioxidative (e.g., ascorbate, glutathione and alpha-tocopherol) and photoprotective (e.g., xanthophyll cycle pigments) defense systems. We investigated the defense capacities of three tree age classes (mature, sapling and seedling) of Norway spruce (Picea abies (L.) Karst.) at a field site near the timberline. Biochemical data were expressed on both a needle dry mass and a surface area basis. Compared with current-year needles, previous-year needles contained higher mass- and area-based concentrations of chlorophylls and alpha-tocopherol, and a larger xanthophyll cycle pool that was in a more epoxidized state. Total glutathione concentration was lower, the glutathione pool was more reduced and the ascorbate pool was more oxidized in previous-year needles than in current-year needles. Needle concentrations of glutathione and alpha-tocopherol increased and chlorophyll concentration decreased with increasing tree age when expressed on a surface area basis. On a dry mass basis, these trends were reversed or nonexistent. The ascorbate pool was more reduced and the glutathione pool was more oxidized in needles of mature trees than in needles of saplings and seedlings. The proportion of protective xanthophyll cycle pigments decreased and the de-epoxidation state increased with increasing tree age. We conclude that tree age and the basis of expression of antioxidant concentration--surface area or dry mass--are important in scaling from seedlings to large trees.
Antioxidants↗
A prospective randomised study to evaluate the effectiveness of standard 23 gauge fine needle, compared with a thinner 27 gauge needle for breast cytology.
The aim of this study was to determine whether a 27 gauge needle could be used to obtain adequate cytology with less discomfort to the patient. Two types of needles were compared-23 gauge (blue) needle versus 27 gauge very fine needle. The cytology specimen was assessed for quality in terms of adequacy for diagnosis. Ninety samples were randomised into this study. The quality of samples was similar in both groups; there was no statistical difference in the quality of samples obtained. The 27 gauge needle produced two inadequate samples (4.4%), whereas there were no inadequate samples with the 23 gauge needle. There was no statistical difference in the amount of blood on the slide between the two groups. The pain scores were significantly better with the finer needle (P=0.004). This study provides evidence that the 27 gauge FNAC is suitable for obtaining cytology in palpable breast lumps.
Biopsy, Fine-Needle↗