Role of syringe holder in reducing needle stick injuries

Abstract

Sir, This is in response to the article by Kumar et al,[1] entitled “Needle stick injuries during fine needle aspiration procedure: Frequency, causes and knowledge, attitude and practices of cytopathologists”, whereby the authors have aptly described the various causes leading to needle stick injury (NSI) during fine needle aspiration (FNA) procedure and have also discussed about various methods to reduce NSI. We appreciate the authors’ effort for analyzing in detail the practical aspects of FNA procedure, which are not very often discussed. We completely agree with the authors’ and would like to carry forward the discussion on ‘how to reduce NSI’ and suggest a few small but beneficial methods to tackle the problem. For reducing the chances of NSI, the authors have cited a couple of syringe modification methods adopted by Halsell,[2] and Galed-Placed et al,[3] both of which prevents needle manipulation for aspirate evacuation from syringe. The former proposes creating a small hole, punctured in the barrel of a syringe above the level to which the plunger is routinely retracted, allowing the syringe to fill with air. The specimen can then be expressed onto a slide without the necessity of removing and reattaching the needle. The method adopted by Galed-Placed et al,[3] proposes initiating FNA with two mL of air in the syringe, which can be used to empty the needle without its manipulation. We would like to highlight the importance of syringe holder, which places the cytopathologist at comfort by providing more stability to the hand performing FNA and leaves free the other hand for immobilising the swelling. Regular use of syringe holder will train the cytopathologist and instil more confidence, thereby reducing risk of NSI. Another important factor we would like to focus on is the volume of syringe. Haseler et al,[4] found that 20 ml syringes achieved a vacuum of -517 torr, but required far more strength to aspirate and resulted in significant loss of needle control, thereby increasing the chance of NSI. The 10 or 5 ml syringes generated only 15% less vacuum (-435 torr) than the 20 ml device and required much less hand strength, providing significantly enhanced needle control. In line with the conclusion drawn by Haseler et al,[4] we propose that to optimise control of needle (which will help reduce NSI), and to maximize fluid and tissue yield during aspiration procedures, the smallest syringe size adequate for the procedure should be used. To reduce NSI in patient related predisposing factor e.g. small lumps which are difficult to fix and slip between hands as well as for deep seated swellings – we would like to suggest ultrasound guided FNA for these difficult masses. Ultrasonography exactly delineates the lesion and indicates the optimal depth of the lesion; it can guide the needle to a solid portion, if the lesion is partly cystic. Lastly, instead of recapping the needle after FNA procedure, if the needle can be crushed and destroyed safely in a needle crusher, while still attached to the syringe, it will be of help in reducing chance of NSI. Although we understand the availability of the instrument is a pre-requisite, it may not be feasible at all setups.