The Needle Safety Regulation (O. Reg. 474/07) under Ontario’s Occupational Safety and Health Act (OSHA) was extended to include dental offices as of July 1, 2010. This Regulation mandates the use of safety-engineered needles (SEN) as opposed to conventional hollow-bore needles in dentistry, as well as in other healthcare professions and locations. This Regulation is enforceable by the province’s Ministry of Labour. Strictly speaking, non-compliance with OSHA is illegal and punishable by fines up to $25,000 and/or imprisonment up to 12 months.1 Clearly then, compliance with this Regulation is in any dentist’s best interest.
Currently there is only one option for intraoral injection from Septodont (Ultra Safety Plus XL). Its design and use has recently been reviewed elsewhere, so the focus of this article is on the intramuscular and intravenous aspects of drug administration in dental practices.2 After contacting a number of companies some of them (Becton Dickinson, The Kendall Company and Terumo) sent a number of their SEN products to the author for clinical use. The following briefly relates the subsequent clinical experiences with these devices. The products in this review are grouped alphabetically. This review is not intended to be authoritative or all-inclusive, but will hopefully serve as a guide to help other clinicians choose their SEN products.
- BD AngiocathTM AutoguardTM and InsyteTM AutoguardTM IV catheter (Becton Dickinson Infusion Therapy Systems Inc., Utah, USA)
- Safety mechanism: A button-activated, active system that retracts the entire steel needle into an enclosed, plastic hub.
- Pros: Visibility of flashback of blood is good, as one’s fingers are not near the flash chamber. Protection from the needle is complete.
- Cons: The units are longer and therefore more cumbersome in their handling than their non-SEN counterparts. In addition to less comfort for the practitioner, the size of the Autoguards can lead to greater patient anxiety at the time of venipuncture. Because of the button’s positioning, there is also the fear of inadvertently activating the retraction mechanism unintentionally. The retraction of the needle makes a snapping sound, which has startled patients.
- BD EclipseTM injection needle (Becton, Dickinson and Company, NJ, USA)
- Safety mechanism: Designed for smallpox vaccinations, this system has a pink, hinged safety cover that is pushed with one hand to lock over the needle.
- Pros: One-handed operation. Audible and tactile lock when the cover is engaged.
- Cons: Use of this syringe is easiest when the time is taken to flip the cover as far back as possible. This can pose a visibility problem when drawing drugs from a vial or ampoule depending on the orientation of the cover when the Luer-Lok needle is attached.
- BD IntegraTM syringe (BD, NJ, USA)
- Safety mechanism: A spring-loaded, retracting needle that is activated by pushing the plunger in a little further after the whole volume has been injected.
- Pros: Efficient design with no apparent extra parts. Easy to activate the safety mechanism with the same thumb (or finger) that gave the injection.
- Cons: Need to draw exactly the amount to be delivered each time, which could be an issue with sedative agents drawn from vials or ampoules. The possibility of premature or delayed activation of the safety spring depending on the type of injection or the characteristics of the skin or tissue being injected.
- BD Saf-T-IntimaTM IV catheter (Becton Dickinson Infusion Therapy Systems Inc., Utah, USA)
- Safety mechanism: A passive shielding system that uses a telescoping needle shield to cover the needle on withdrawal.
- Pros: Familiar butterfly design. Passive shielding system. Includes a Y-adapter that allows for needleless access to the system.
- Cons: The telescoping needle shield system is long (approx. 10 cm) which makes the system technique-sensitive, as the shield dangles while the vein is being accessed.
- Kendall Monoject MagellanTM safety needle (The Kendall Company, MA, USA)
- Safety mechanism: An unfolding (simple accordion type), locking sheath that is attached to the needle hub is activated by a thumb, finger or hard surface after injection.
- Pros: The sheath is held in a relatively unobtrusive position before and during use. Sturdy sheath. Smooth sheathing action with an auditory click on locking.
- Cons: Bulky packaging, but this is quibbling.
- Terumo SurGuard2TM hypodermic needle (Terumo Medical Products, NJ, USA)
- Safety mechanism: A blue, hinged needle safety sheath that is pushed over the needle after use by using a hard, flat surface.
- Pros: Negligible risk to the user for needlestick injury because of the use of an inanimate object to activate the safety device. An audible click for the cover with most needle sizes; some of the smaller sizes are not as reliable for the click.
- Cons: Proper preparation of the needle has the protective sheath at a 90-degree angle to the syringe; this adds apparent bulk and inconvenience to the system. The immediate post-use need for a hard, flat surface after giving the injection in order to activate the safety mechanism.
- Terumo SurshieldTM IV catheter (Terumo Medical Products, NJ, USA)
- Safety mechanism: A passive shielding system where a metal needle cover flips over the steel needle tip when it is withdrawn from the catheter.
- Pros: The appearance/size and handling of the Surshield® is exactly like non-SEN units. The safety cover is inside the catheter’s hub. The SurFlash® flashback system tells you separately when the needle, and then the catheter are inside the vein.
- Cons: Some technique sensitivity to the withdrawal of the steel needle in order for the safety mechanism to be activated (e.g. angulation).
- Terumo SurshieldTM safety winged infusion set (Terumo Medical Products, NJ, USA)
- Safety mechanism: A hinged sheath that is flipped toward the needle after withdrawal from a vein. The shield is finally placed by pushing the shield down onto a hard surface.
- Pros: There is a click when the shield has been placed correctly. The wings of the butterfly can interlock.
- Cons: The steel needle is left inside the vein throughout the length of the procedure, which leaves the vein at increased risk of damage from patient movement. The safety shield is present throughout the length of the procedure presenting another risk to the vein from inadvertent movement of the patient or practitioner.
It is the author’s wish that this brief review will assist the reader in making a decision as to which of the available SEN systems he/she will choose to use for the IM/IV part of their practice of dentistry or in their treatment of medical emergencies. OH
Dr. Peter Nkansah is a dentist-anaesthesiologist with a private practice in Toronto. He is also past President of the Canadian Academy of Dental Anaesthesia, an international lecturer, and a member of the teaching staff in the Discipline of Anaesthesia at the Faculty of Dentistry, University of Toronto.
Oral Health welcomes this original article.
/www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90o01_e.htm#BK84. Accessed January 6, 2011.
2. Isen D and P Nkansah. Needle Safety Regulation 474/07: Clinical Implications and Applications. Ontario Dentist; September 2010: 24-29.