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Influence of needle type on the incidence of intravascular injection during transforaminal epidural injections: a comparison of short-bevel and long-bevel needlesMatthew Smuck et al. Spine J. 2010 May. AbstractBackground context: Vascular penetration and injection of corticosteroids into a vessel during lumbosacral transforaminal epidural injection is a suspected cause of myelopathy. Blunt needles have been suggested to avoid vascular penetration, but they are difficult to navigate. Another alternative to the standard long-bevel sharp needles is the short-bevel needles. Some have postulated that short-bevel needles are the best option for high-risk spine injections because they maintain navigation characteristics while potentially reducing the risk of complications. To date, no studies have been performed to either confirm or refute this. Purpose: The purpose of this study was to determine if there is a difference in the incidence of vascular penetration during lumbosacral transforaminal epidural injections between short-bevel and long-bevel needles. Study design/setting: This is a prospective, observational, in vivo study. Patient sample: The sample comprises patients receiving lumbosacral transforaminal epidural injections at a university-based outpatient spine center. Outcome measure: The outcome measure was the incidence of vascular contrast patterns observed under live fluoroscopy. Methods: One interventional spine physician recorded contrast patterns observed during 158 fluoroscopically guided lumbosacral transforaminal epidural injections under live fluoroscopy using two different types of needle tips. Results: Vascular injections were observed in 22 of the 158 injections, for an overall incidence of 13.9%. The incidence of vascular injections in the short-bevel group was 15.6% (10/64) and in the long-bevel group was 12.8% (12/94). This difference was not statistically significant (p=.6447). A secondary analysis was performed to determine if the needle gauge influenced the incidence of vascular injections, and again, there were no statistical differences in the overall rates of vascular injection. Conclusions: In comparison with long-bevel needles, short-bevel needles do not reduce the risk of inadvertent vascular injection in lumbosacral transforaminal epidural injections. Copyright 2010 Elsevier Inc. All rights reserved. Comment in
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What is a short bevel needle?Generally, short bevel needles are used for vascular access so that the whole bevel length is easily inserted into the vein. Therefore, penetration forces generated by short bevel needles are relatively large compared with those produced by regular bevel needles.
Why is position of the bevel of the needle relevant in injections?Keeping the bevel side up allows for smooth piercing of the skin and induction of the medication into the dermis. 14. Once syringe is in place, slowly inject the solution while watching for a small weal or bleb to appear.
Why does an injection needle have a beveled edge?All needles have a point at the end that is sharp, but becomes “burred”, or dull after use. This is why needles are meant for single use injections. Needles have a beveled edge. The beveled edge should point upwards for an injection to allow for better administration of the medication.
Which bevel is the most common and used for a vast majority of applications?Regular bevel: The most common bevel, used for a vast majority of applications . Typically used for intramuscular and subcutaneous injections .
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Short bevel vs long bevel needle
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