title: Unintentional vascular uptake in fluoroscopically guided, contrast-confirmed spinal injections: a 1-yr clinical experience and discussion of findings.
abstract: 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.
authors.affiliation: Department of Neurosciences, Surgical Neurology of North Central Ohio, MedCentral Hospital Mansfield, Mansfield, OH, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Stretanski
authors.forename: Bohdan
authors.initials: B
authors.lastname: Chopko
mesh_terms: 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
chemical_list: D003287:Contrast Media