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Safety Syringes and Anti-Needlestick Devices in Orthopaedic Surgery

Sibbitt, Wilmer L. Jr, MD1; Band, Philip A., PhD2; Kettwich, Lawrence G., BS1; Sibbitt, Cristina R., BS3; Sibbitt, Lori J., BS4; Bankhurst, Arthur D., MD1

doi: 10.2106/JBJS.J.01255
Scientific Articles
Supplementary Content

Background: The American Academy of Orthopaedic Surgery (AAOS), The Joint Commission, the Occupational Safety and Health Administration (OSHA), and the Needlestick Safety and Prevention Act encourage the integration of safety-engineered devices to prevent needlestick injuries to health-care workers and patients. We hypothesized that safety syringes and needles could be used in outpatient orthopaedic injection and aspiration procedures.

Methods: The study investigated the orthopaedic uses and procedural idiosyncrasies of safety-engineered devices, including (1) four safety needles (Eclipse, SafetyGlide, SurGuard, and Magellan), (2) a mechanical safety syringe (RPD), (3) two automatic retractable syringes (Integra, VanishPoint), (4) three manual retractable syringes (Procedur-SF, Baksnap, Invirosnap), and (5) three shielded syringes (Safety-Lok, Monoject, and Digitally Activated Shielded [DAS] Syringe). The devices were first tested ex vivo, and then 1300 devices were used for 425 subjects undergoing outpatient arthrocentesis, intra-articular injections, local anesthesia, aspiration biopsy, and ultrasound-guided procedures.

Results: During the clinical observation, there were no accidental needlesticks (0 needlesticks per 1300 devices). Safety needles could be successfully used on a Luer syringe but were limited to ≤1.5 in (≤3.81 cm) in length and the shield could interfere with sonography. The mechanical safety syringes functioned well in all orthopaedic procedures. Automatic retractable syringes were too small for arthrocentesis of the knee, and the plunger blew out and prematurely collapsed with high-pressure injections. The manual retractable syringes and shielded syringes could be used with conventional needles for most orthopaedic procedures.

Conclusions: The most effective and reliable safety devices for orthopaedic syringe procedures are shielded safety needles, mechanical syringes, manual retractable syringes, and shielded syringes, but not automatic retractable syringes. Even when adopting safety-engineered devices for an orthopaedic clinic, conventional syringes larger than 20 mL and conventional needles longer than 1.5 in (3.8 cm) are necessary.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

1Department of Internal Medicine, University of New Mexico Health Sciences Center, Fifth Floor ACC, Mail Stop: MSC10-5550, Albuquerque, NM 87131. E-mail address for W.L. Sibbitt Jr.: E-mail address for L.G. Kettwich: E-mail address for A.D. Bankhurst:

2Departments of Orthopaedic Surgery and Pharmacology, New York University Hospital for Special Surgery, 301 East 17th Street, New York, NY 10003. E-mail address:

3710 A Skylark Court, Missoula, MT 59801. E-mail address:

4702 Madison Avenue, Helena, MT 59601. E-mail address:

Copyright © 2011 by The Journal of Bone and Joint Surgery, Incorporated
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