Using a Double Syringe Sterile System for MSK Aspiration/Injection Procedures Eliminates Risk of Iatrogenic Infection

Figures & data

Figure 1 (A) double syringe system type A using the three way stopcock Discofix-3, with a 5 mL syringe for treatment solution and a 20 mL syringe for aspiration; (B) double syringe system type B using a standard i.v. catheter with aspiration syringe connected after placing the needle in place and removal of the guide needle.

Table 1 Study Group Characterization

Characteristic	Number of Patients, %, or Mean ± SD
Total number of patients	1024
Number of patients treated with DSSA	1020
Number of patients treated with DSSB	4 (The second type of assembly proved impractical in clinical setting and procedures using this type of assembly were stoped in the early stages of our study).
Sex	73% female, 27% male
Age	59 ± 16 years old
Admission primary diagnosis	Coxarthrosis 22%, Gonarthrosis 78%
Associated MSK pathology that was addressed using the DSSA during hospital stay	Shoulder Subacromial bursitis 15% Baker cyst 14% Calcific supraspinatus tendinopathy 10% Tenosinovitis 9% Synovial cyst 6% Suprapatelar bursitis 2% Milwakee shoulder arthropathy 0.1%
Patients that underwent multiple procedures (either for different joints or different pathologies)	60%
Septic local complications at the 6 week follow-up examination	0%
Functional improvement after visco-elastic supplementation of the knee/hip (6 week follow-up visit)	88% (12% of patients declared sationary evolution of their clinical symptoms)
Clinical improvement after local corticosteroid injection for diverse MSK pathology (6 week follow-up visit)	92% of patients described major improvement of pain and function (8% declared stationary evolution)

Figure 2 (A) system is set for aspiration after the needle will be in place, red arrows demonstrate the direction of the aspirate from tip of needle towards the aspiration syringe; (B) aspiration is completed and stopcock is rotated clockwise. The red arrow indicates the 90 degree rotation of the stopcock, to block the aspiration syringe and open the injection syringe; (C) treatment solution can be administered without changing needle tip location. The red arrows indicate the direction of injectate flow from medication syringe to the tip of the needle location; (D) double syringe system at the end of the procedure.

Figure 3 Technique presentation for aspiration/injection procedure of a wrist synovial cyst; (A) approach and needle placement was done after understanding local anatomy with sonography, with wide skin preparation and sterile technique under local anesthesia; (B) aspiration of cyst content; (C) injection of corticosteroid after aspiration is completed; (D) 6 week follow-up visit with clinical assessment (patient used compressive bandage during activities after the procedure).

Figure 4 Sonography images collected from our series of patients; (A) image obtained during vasco-supplementation of the Hip using the convex probe, with obvious thickening of the joint capsule and small quantity of intra articular fluid; (B) image obtained from a patient suffering from Milwaukee Shoulder arthropathy were evacuation was attempted (with no success due to high viscosity of intra articular deposits) before local steroid injection.