Universal Precautions

Face shields

The provider should wear eye protection at all times during any procedure involving bodily fluids. Face shields obviously should be worn during irrigation, when blood can splash into the eyes. During infiltration, bloody anesthetic fluid under pressure can spray into the eyes. Even during seemingly safe procedures like suturing small lacerations, blood can flick off the suture needle into the providers face.

Gloves

Gloves should be worn at all times during any invasive procedure. Sterile gloves need not be worn for simple infiltration of anesthesia, provided that the needle nor the sterilized skin is NOT touched by an unsterile glove. During sterile procedures (such as laceration repair), the clinician may find it conveinent to do infiltration with sterile gloves on, negating the need to change gloves prior to the completion of the procedure.

Gowns

Gowns are not required for simple infiltration of local anesthesia, but should be worn during procedures in which there is a likelihood of contamination.

For more information on sterile technique, please refer to the Sterility section of the General Principles chapter.

Antiseptic Solutions

Skin around overlying an injection site (or a wound) should be sterilized with an antiseptic solution so that bacteria on the skin is not introduced into subcutaneous tissue during infiltration or suturing. Common antiseptics include betadine and chorhexadine, and many other products are available. Antiseptic solutions can damage mucosal surfaces and subcutaneous tissue and should never be placed directly into a wound. It is prudent to prepare a wide sterile area so that instruments and suture material do not touch contaminated skin during the procedure. For more information, please refer to the Sterility section of the General Principles chapter.

Needles and Syringes

Needles

Needles: Larger bore needles, 18- to 19-gauge, are used to quickly draw anesthetic into a syringe, but are too large to be sued for the actual infiltration. Needle-less devices are also available for drawing up medication. The smallest needle possible should always be used for infiltration, never using larger than 25-gauge. Longer small gauge needles, like a 1- to 1.5 inch 27 gauge allow more infiltration without having to withdraw and reinsert the needle.

Syringes

Syringes: Choose the syringe size appropriate for the volume of anesthetic needed. Try to use the smallest syringe possible, because larger syringes generate more pressure, and infiltration is less painful when it done under the lowest pressure possible. For large wounds, it is vital to keep track of how much agent has been drawn up and injected to avoid exceeding the maximum dose. Easy rule of thumb: one 30-cc syringe is the maximum dose of lidocaine 1% without epinephrine.

Anesthetics

Anesthetic agents come in a variety of containers and packaging. It is crucial to confirm the correct agent, concentration and adjunct are being used. Agents with epinephrine generally have epinephrine printed in red ink for easy visibility. Single use vials often have a glass bulb, which is snapped off to open the container. Multi-use containers, with rubber tops, should never be used on more than one patient; be sure to dispose of them after use. The top of the container should sterilized with an alcohol wipe and the drug should always be drawn up using a sterile needle.