Unintentional vascular uptake in fluoroscopically guided, contrast-confirmed spinal injections: a 1-yr clinical experience and discussion of findings.
OBJECTIVE
Documentation of vascular uptake on spinal injection in the context of negative aspiration and negative passive filling of blood into the hub of the needle.


METHODS
A total of 1,295 consecutive outpatients receiving fluoroscopically guided, contrast-confirmed injection in a multispecialty practice over a 1-yr time frame were retrospectively reviewed with passive observation for inadvertent vascular uptake, passive filling, and required repositioning.


RESULTS
Positive vascular uptake was seen in 2-13% of cases with variable degrees of aspiration, passive filling, and required needle repositionings to avoid vascular uptake.


CONCLUSIONS
Negative aspiration and allotment for passive filling is inadequate to confirm the absence of vascular injection. Spinal injection will never be risk free. The safest method is fluoroscopically guided, contrast-confirmed injection, which should be considered the current standard of care.
Stretanski
Michael F
MF
Department of Neurosciences, Surgical Neurology of North Central Ohio, MedCentral Hospital Mansfield, Mansfield, OH, USA.
Chopko
Bohdan
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000379:methods / Q000706:statistics & numerical data*; D000775:Anesthesia, Spinal / Q000379:methods / Q000706:statistics & numerical data*; D001808:Blood Vessels; D003287:Contrast Media / Q000493:pharmacokinetics*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000453:epidemiology; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007278:Injections, Spinal / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D012189:Retrospective Studies; D013396:Suction
D003287:Contrast Media