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ARMAMENTARIUM

by Dr. Helen R. Hallare

The materials used to obtain regional analgesia:


1. 2. 3. 4. syringe needle cartridge auxiliary materials

SYRINGE

the vehicle whereby the contents of the local anesthesia cartridge can be delivered through the needle to the patient

Types of Syringes

According to Resterilizability Reusable Disposable

Types of Syringes

According to Form (conventional types)


Breach-loading, metallic cartridge type Jet injector Periodontal ligament/Intraligamentary injection syringe Plastic disposable syringe

Breach-loading, metallic cartridge type


1.

2.
3.

Aspirating syringe Non-Aspirating syringe Self-Aspirating syringe

Aspirating Syringe
With harpoon or claw attached to the piston that is used to penetrate the thick rubber or silicone stopper of the cartridge -Astra aspirating syringe - Cook-Waite carpule syringe

Self-Aspirating Syringe

obtain required negative pressure for aspiration by means of the elasticity of the rubber diaphragm of the anesthetic cartridge

Advantages of Aspirating syringes


1. 2. 3. 4.

5.

visible cartridge aspiration with one hand autoclavable rust resistant long lasting with proper maintenance

Disadvantages of Aspirating syringes


1. Weight 2. size may be too big 3. possibility of infection with improper care

Non-Aspirating Syringe

justifiable only for application of medicaments into a root canal during endodontic treatment.

Self-Aspirating Syringe

A metal projection is present inside the syringe, which directs the needle into the cartridge. This is where the diaphragm rests

Self-Aspirating Syringe

Advantages of Self-Aspirating Syringes


1. cartridge is visible 2. easier to aspirate with smaller hands 3. Autoclavable 4. rust resistant

Disadvantages of Self-Aspirating Syringes


1.

2.

same as the above mentioned disadvantages feeling of insecurity for sectors accustomed to harpoon-type syringe

Jet Injectors

For needleless injection based on the principle that liquids forced through very small openings called jets at very high pressure can penetrate skin of mucous membrane

Jet Injectors

Delivers calibrated volume of anesthetic solution from 0.05 to 0.2 ml of the solution at 2000 lbs/sq. in. pressure

Advantages of Jet Injectors


1. 2.

3.

Does not require the use of needle Delivers very small volume of local anesthetic Used in lieu of topical anesthesia

Disadvantages of Jet Injectors


1.

2.

3.

Inadequate for pulpal or regional block The jolt may be disturbing to some patients cost

Periodontal ligament/Intraligamentary Injection syringe

Provides pulpal anesthesia for one isolated tooth, even in the mandibular arch

Periodontal ligament/Intraligamentary Injection syringe

Encloses the glass cartridge protecting the patient should the cartridge crack or shatter during injection

Advantages of Intraligamentary injection Syringe


1.
2. 3.

Measured dosage Overcomes tissue resistance Protected cartridge

Disadvantages of Intraligamentary Injection Syringe


1. 2. 3.

Injects too rapidly Cost Original designs look threatening

Plastic Disposable syringe


Employed for I.M. or I.V. injections Used only when a traditional syringe is not available

Advantages of Plastic disposable syringes


1.

2.
3.

Single use Sterile until opened Lightweight

Disadvantages of Plastic Disposable Syringes


1.

2.

Does not accept prefilled dental cartridge Difficult aspiration

Needles

Needles

Made of platinum, stainless steel (most widely used) iridioplatinum alloy or platinumruthenium An alloy of base metals nickel, chromium, cobalt, molybdenum, tungsten and steel

Needles

Available in many different bevels: short beveled needle is superior to the long tapering bevel for regional analgesia since it is less likely to be defelected from it intended path during insertion

Advantages of Stainless Steel Needles


1.
2. 3. 4.

5.

It is rigid enough to be easily guided during insertion It maintains an extremely sharp point It is inexpensive enough to be discarded after use with each patient Breakage rarely occurs if the needle is properly handled It is available in a variety of lengths, gauges and styles

Needle Gauge

A 25-gauge or preferably a 27-gauge is indicated The gauge of needles are indicated by number, with the higher gauge number denoting the smaller diameter of the shaft

Needle Gauge

20 21 22 23 24 25 27 30

gauge gauge gauge gauge gauge gauge gauge gauge

0.81 0.72 0.64 0.57 0.51 0.45 0.40 0.35

mm mm mm mm mm mm mm mm

diameter diameter diameter diameter diameter diameter diameter diameter

Needle Length

Long 1 5/8 inch; short 1 inch Should not be introduced more than half or two thirds of its shaft length into the tissuepermits a sufficient length of the needle to protrude from the tissue in case of breakage

Cartridges

Contents are made up of various ingredients that combine to form the anesthetic solution

Contains the following ingredients:


1. 2. 3. 4. 5. 6.

The anesthetic drug or combination of drugs The vasoconstrictor in various concentrations per milliliter A preservative, usually sodium bisulfite Sodium chloride to make the solution isotonic Distilled water in sufficient volume to equal the desired amount Methylparaben, a germicide, found in some brands of anesthetic solutions

Problems commonly encountered with the following armamentarium

Needle
Pain

Dull needles Fish hook like barbs

Needles

Breakage Bending Changing the direction of the needle while embedded into the tissue Forcing against resistance

Cartridge

Leakage during injection


Off center perforation on the rubber diaphragm

Extruded stoppers
Freezing of cartridge Diffusion of sterilizing agent into the cartridge Produces bubbles bigger than the usual 12 mm

Cartridge

Burning on injection site


Contaminated solution Overheated cartridge Normal response to the pH of drug Anesthetics with vasoconstrictors

Cartridge

Sticky rubber stoppers During cold days Corroded caps & rust on caps Immersion of cartridge to sterilizing solution Breakage of cartridge Occurs at the neck of the cartridge where it joins the cap and also at the area of rubber plunger

Syringe

Disengagement of harpoon from rubber stopper during aspiration


Due to dull harpoon Too much pressure to the thumb ring

Surface deposits
Accumulation of debris, saliva and disinfectant solution

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