Needle through needle technique

[Baron Samedi]

A rep at a dinner mentioned that this has been essentially debunked as a method of preventing infections -- didn't provide a source. I've been trying to find some data one way or another but have yet to find anything. Does anyone have any sources regarding the efficacy or lack-thereof in infection prevention?

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[lobelsteve]

Infections are not of enough frequency to determine technique difference with all of the confounding other factors.
N would be in the 10s of thousands.

 

[Doctodd]

A rep at a dinner mentioned that this has been essentially debunked as a method of preventing infections -- didn't provide a source. I've been trying to find some data one way or another but have yet to find anything. Does anyone have any sources regarding the efficacy or lack-thereof in infection prevention?

a rep? That says it all.

But isnt the double needle technique more about using one needle as a trochar and the other to actually do the injecting? Maybe look for data regarding infections with trochars instead of needles...or even arthroscopic procedures.

 

[Baron Samedi]

a rep? That says it all.

But isnt the double needle technique more about using one needle as a trochar and the other to actually do the injecting? Maybe look for data regarding infections with trochars instead of needles...or even arthroscopic procedures.

I've heard both -- as a tool for maneuverability and also as infection prevention. The 1st point is practical and the 2nd one I'm just unsure of.

 

[RoloTomassi]

It makes impossible high crest L5-S1 possible so I'd do it regardless of infection risk mitigation

 

[MD87]

I think there is a factfinder on this. But essentially, there is mixed data with too small of an N to make a strong recommendation one way or another.

 

[Espn123]

i must be the only one who doesn’t have a clue what this is talking about

 

[deleted875186]

It makes impossible high crest L5-S1 possible so I'd do it regardless of infection risk mitigation

I don’t understand, how does this help more than just using a curved tip needle.

 

[Baron Samedi]

i must be the only one who doesn’t have a clue what this is talking about

You use an introducer needle to go through skin and soft tissue then a smaller needle through that to get to the final destination.

 

[drmamba]

Sounds like they're trying to sell more needles or make incremental changes to their kits to justify increased prices or superiority over their competitors

 

[Taus]

I don’t understand, how does this help more than just using a curved tip needle.

Have you ever done a discogram at L5-S1 with very high and medial iliac crests? I also do this on a very rare basis for tfesi at this level. Introducer needle in straight AP/ferguson and lateral to just past the S1 SAP/ala. Then hockey stick bend on smaller needle curves directly to target.

 

[Orin]

So the skin/connective tissue is too tough, so you're putting a 18g in first and then using that as an introducer to then drive a smaller gauge needle into the target?

I'm not sure how that's going to reduce infection, but I can see how it helps with maneuverability. I mean maybe you'll reduce the risk of a deep infection if you assume the two needle tips don't really touch, but we may as well cross our fingers and hope.

I agree though with @dipriMAN, I can normally do this with just a larger gauge curved needle for the maneuverability aspect. I suppose if you must use a 25-30g this would be useful.

 

[Baron Samedi]

So the skin/connective tissue is too tough, so you're putting a 18g in first and then using that as an introducer to then drive a smaller gauge needle into the target?

I'm not sure how that's going to reduce infection, but I can see how it helps with maneuverability. I mean maybe you'll reduce the risk of a deep infection if you assume the two needle tips don't really touch, but we may as well cross our fingers and hope.

I agree though with @dipriMAN, I can normally do this with just a larger gauge curved needle for the maneuverability aspect. I suppose if you must use a 25-30g this would be useful.

Another example where it might be practical -- say you wanted to do a transaortic celiac plexus block but wanted to go through big red with as small of a needle as possible. You can use a larger bore needle to get past the vertebral body with some decent maneuverability, then feed the flimsier 25G through for the last little bit.

 

[RoloTomassi]

I don’t understand, how does this help more than just using a curved tip needle.

Here's what I do: tilt to square the disc, oblique as much as you can before crest covers disc, put introducer in, touch anterior SAP then walk off. Turn bevel to face medial. The inner needle I bend to a springy curve ~45 degrees by putting the tip in the plastic sheath, grabbing shaft a few inches down and curling it. Put this in the introducer curving medially. It'll be spring loaded and shoot out medially. Once in the annulus, retract the introducer a few cm to accentuate the curve of the inner needle when advancing.

 

[Ducttape]

Infections are not of enough frequency to determine technique difference with all of the confounding other factors.
N would be in the 10s of thousands.

if i were the researcher, i would do power analyses as part of the initial make up of the study to determine the amount of data necessary.

then i would start on an animal model, such as the rat.

 

[nvrsumr]

Interesting how thoughts on this subject have changed. For what its worth I dont use two needle and do use abx.

 

[RoloTomassi]

Fwiw I do 2 needle + IV abx (ancef) + intradiscal abx (gent per Lutz article)

 

[Baron Samedi]

Interesting how thoughts on this subject have changed. For what its worth I dont use two needle and do use abx.

Thanks for the article. I'll have to look at their source, but in the discussion they mentioned risk of discitis reduced from 2.7% to 0.7% which seems pretty substantial.

 

[Ferrismonk]

Interesting how thoughts on this subject have changed. For what its worth I dont use two needle and do use abx.

Maybe I'm dumb here, but I thought I was following this conversation pretty well and I completely didn't recognize you guys were talking about discograms.

Who tf does discograms anymore?

 

[Baron Samedi]

Maybe I'm dumb here, but I thought I was following this conversation pretty well and I completely didn't recognize you guys were talking about discograms.

Who tf does discograms anymore?

Not necessarily discograms but this came up at a Viadisc dinner. I haven't done a discogram in >5 years so that's where my question came from.

 

[nvrsumr]

Been a hot minute since I've done a discogram. Sporadic intradiscal bmac but I'm not a huge fan of poking discs.

 

[bedrock]

Been a hot minute since I've done a discogram. Sporadic intradiscal bmac but I'm not a huge fan of poking discs.

How did things go with those intradiscal BMACS?

 

[lobelsteve]

How did things go with those intradiscal BMACS?

100% success in getting paid up front, other outcome measures spotty.

 

[nvrsumr]

You gotta BELIEVE