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Armamentarium and preparation for basic injection


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  • 1. Armamentarium and Preparation for basic injection Dr. Hesham El-Hawary ELHAWARY
  • 2. Pre-anesthetic evaluation of the patient1. Case History2. Local Examination3. Patient Grouping and sensitivity test4. Discussing with the patient the Treatment Plan ELHAWARY
  • 3. Case History• Personal data name, age, sex, occupation, etc• History of chief complaint• Past medical history• Past dental history• Family history• Review Of systems ELHAWARY
  • 4. Case History Cont.• Advantages of taking Case history: – Establishing a diagnosis – Establishing the patient’s general condition and hence his ability to withstand the procedure and the kind of anesthesia – Establishing sound doctor-patient relationship ELHAWARY
  • 5. Local Examination• The region to be operated on• Evaluation of the surgical work to be done – Severity – Time required• Evaluation of any obstacles in the site of injection – Anatomical – Septic – Mechanical ELHAWARY
  • 6. Patients grouping• Group I: Completely fit for Local Anesthesia• Group II: II: Patients who need medical consultation with specialist and/or physician• Group III: III: Patients who are contraindicated for local anesthesia ELHAWARY
  • 7. Group I: Fit for local anesthesia1. Receive injection without premedication2. Premedicated before injection: 1. Allergic patients →Sensitivity test 2. Nervous patients →Tranquilizer (Atarax) 3. Toxicity → Barbiturates 4. Infection → Antibiotics ELHAWARY
  • 8. Skin Sensitivity Test• Depositing 0.1 ml of the test solution into the patients forearm• The area to be injected is first wiped with an alcohol pad• A small intradermal wheel about 5 mm in diameter is raised with saline injection• A similar wheel 3 or 4 cm away is also raised with the local anesthetic to be tested ELHAWARY
  • 9. • After 5 minutes, both wheels are examined• Results: – Negative Sensitivity: Both alike – Positive sensitivity: Erythema ELHAWARY
  • 10. ELHAWARY
  • 11. Intranasal Sensitivity Test• This test should supplement the skin test• Place the patient in supine position• Record the blood pressure and pulse every 3 minutes• One drop of the local anesthetic solution to be tested is placed in each nostril while recording the blood pressure and pulse ELHAWARY
  • 12. Intranasal Sensitivity Test Cont.• After 3 minutes 2 drops are placed minutes, in each nostril• This procedure is repeated every 3 minutes increasing the number of drops placed in each nostril until reaching 4 drops / nostril ELHAWARY
  • 13. Intranasal Sensitivity Test Cont.• Then the blood pressure and pulse is recorded for the next 15 minutes• Sensitivity is manifested by significant lowering of the blood pressure and pulse ELHAWARY
  • 14. Discussing with the patient the Treatment Plan• Explain your treatment plan in a simple way• No – Scary – scientific words• Never deny a procedure• Never lie to a child patient ELHAWARY
  • 15. Precautions for Infection ControlBarrier techniqueCare of the handsHandling of sharp instruments and needlesDisinfection and Sterilization of the armamentariumDisinfection and Sterilization of the dental unit ELHAWARY
  • 16. Barrier technique• Gloves• Face protection• Clothes protection ELHAWARY
  • 17. ELHAWARY
  • 18. Care of the hands• Visibly dirty• After touching contaminated objects with bare hands• Before and after patient treatment (before glove placement and after glove removal) ELHAWARY
  • 19. • Handwashing Washing hands with plain soap and water• Antiseptic handwash Washing hands with water and soap or other detergents containing an antiseptic agent• Alcohol-based handrub Rubbing hands with an alcohol-containing preparation• Surgical antisepsis Handwashing with an antiseptic soap or an alcohol-based handrub before operations by surgical personnel ELHAWARY
  • 20. Good Better BestPlain Soap Antimicrobial Alcohol-based soap handrub ELHAWARY
  • 21. Handling of sharp instruments and needles• The needle must be recovered before removal from the syringe• Don’t recap the needle of the cartilage syringe, by its plastic cover using your two hands• Recap the needle by one hand using the table technique• All sharp disposable instruments must be discarded in a puncture resistance container or in the incinerator ELHAWARY
  • 22. ELHAWARY
  • 23. Handling of sharpinstruments and needles Cont. ELHAWARY
  • 24. Disinfection and Sterilization of the armamentarium• All contaminated instruments – Handled with the general purpose utility gloves – Cleaned to remove debris and blood, then dried, wrapped and autoclaved• Anesthetic carpule sterilized from outside by insertion in colored antiseptic solution so that if any leakage occurred the anesthetic solution color will be changed• The handpiece must be cleaned, lubricated and wrapped then autoclaved between patients ELHAWARY
  • 25. Disinfection and Sterilization of the armamentarium ELHAWARY
  • 26. Disinfection and Sterilization of the dental unit• Cover the head rest with disposable towels• The light handles, the control buttons, and the handles of the saliva ejectors and suctions must be covered with aluminum foils or plastic covers• A chemical germicidal spray is used to spray the dental chair and the practice table between patients ELHAWARY
  • 27. Disinfection and Sterilization of the dental unit ELHAWARY
  • 28. ELHAWARY
  • 29. The patient position ELHAWARY
  • 30. • The patient is seated comfortably in the dental chair• The back and the head rest are adjusted so that the patient’s head, neck and trunk are at straight line• The light is adjusted to illuminate the operating field ELHAWARY
  • 31. For working in maxillary teeth• The chair is tilted backward so that the maxillary occlusal plane would be at 45º angle to the floor• The chair is raised up so that the maxillary occlusal plane is two inches below operator shoulder level ELHAWARY
  • 32. For working in mandibular teeth• The chair is tilted backward so that the mandibular occlusal plane would be parallel to the floor when the patient opens his mouth widely• The chair is raised up so that the mandibular occlusal plane should be about two inches above the elbow joint ELHAWARY
  • 33. For working in lower right posteriorteeth the chair is lowered and tiltedenough to enable the operator to havea clear view to the field from behind ELHAWARY
  • 34. The operator’s position ELHAWARY
  • 35. • For anesthesia and extraction of all teeth the operator stands infront and to the right to the patient except in three situations• where he stands from behind and to the right: – Lingual infiltration of lower anterior teeth. – Right handed operator giving left side inferior alveolar nerve block from behind technique. – Extraction of lower right posterior teeth. ELHAWARY
  • 36. Armamentarium used in dental Anesthesia ELHAWARY
  • 37. ELHAWARY
  • 38. Dental Carpule• Glass tube sealed from both ends – One end by a rubber stopper – The other end by a metal cap with rubber diaphragm that is punctured by the needle• Carefully sterilized from outside by keeping them in a colored antiseptic solution• The carpule contains the following: – The anesthetic agent – Vasoconstrictor – Vehicle to make solution isotonic – Preservative ELHAWARY
  • 39. ELHAWARY
  • 40. Dental Syringe• Types: – According to material • Plastic • Metalic – According to aspiration • Aspirating • Non-Aspirating ELHAWARY
  • 41. ELHAWARY
  • 42. ELHAWARY
  • 43. Dental Syringe Cont.• The dental syringe consists of: – Syringe barrel – Finger grip – Thumb ring – Piston – Harpoon – Needle adaptor ELHAWARY
  • 44. Dental Syringe Cont.• There are two types of metallic dental syringes – Basal loading – Lateral loading metal syringe ELHAWARY
  • 45. Dental Syringe Cont.• In the lateral loading dental syringes The piston is retracted to allow space for insertion of the carpule laterally into the syringe barrel• In the basal loading dental syringes The syringe piston is retracted and rotated around the syringe barrel• The needle is then inserted into the threaded part of the syringe barrel (needle adaptor) ELHAWARY
  • 46. Disposable Dental Needle• The dental needle consists of: – Syringe adaptor – Hub – Syringe penetrating end – Needle shank – Needle bevel ELHAWARY
  • 47. Disposable Dental Needle Cont.• There are two types of needles: – Long needles Used during the block injections. – Short needles Used during the infiltration anesthesia.• Once the needle introduced into the tissues never change its direction ELHAWARY
  • 48. Preparation of the site of injection and Needle insertion ELHAWARY
  • 49. • Syringes and Needles: – Chose suitable type syringe and needle should be – The syringe and needle should be carefully sterilized• Hands of the operator: – Washed thoroughly with soap and water – Dried with a sterile towel – Wiped with 70% alcohol• Anaesthetic carpules: – Carefully sterilized – Warmed to body temperature ELHAWARY
  • 50. ELHAWARY
  • 51. • Patients mouth: – Scaling if needed – Rinsing with good antiseptic mouthwash – Draping in the regular manner• Site of injection: – Dried from saliva by a pellet of sterile cotton – Wiped with a disinfectant as 5% tincture iodine ELHAWARY
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  • 53. ELHAWARY
  • 54. • Insertion of the needle: – The patient should be aware that he is going to have the injection but not exactly when – stretched as much as possible to facilitate insertion of the needle – The syringe is held in a pen grasp ELHAWARY
  • 55. ELHAWARY
  • 56. • Insertion of the needle Cont.: – The needle’s bevel of the needle should be directed towards bone or the site of operation – The prick is then made as quickly as possible while guarding with the mirror or fingers of the left hand against any sudden movement of the patient – While starting to inject, try to direct the patients attention to something else ELHAWARY
  • 57. • Insertion of the needle Cont.: – The needle should not be bent to change its direction inside the tissues, it should rather be withdrawn first and then reinserted in the desired direction – The needle should always follow the simplest way inside the tissues to reach its target ELHAWARY
  • 58. • Insertion of the needle Cont.: – After insertion of the needle, aspirate a little, if an aspirating syringe is used, to be sure that the needle is not within a blood vessel, so as to prevent toxicity from the local anaesthetic. – The anaesthetic solution is then deposited at a rate of not more than 2 ml/min, meanwhile the patient should be watched carefully for any adverse reaction ELHAWARY