Some notes on vertiprep

Once clear vision and a stable fulcrum have been established, penetrate the mucosa to a depth of 1-2 mm (approximately the length of the bevel) with the bevel oriented toward bone. A few drops of solution are usually deposited as needles are advanced because even gentle contact with the thumb on the front inner surface of the thumb ring will cause a few drops of anesthetic to be deposited ahead of the needle. Note that this does not require visibly advancing the stopper and no separate action is required other than to proceed slowly. The total volume administered in this manner should be less than 0.2 mL (the volume displaced by 1 stopper length).

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Despite performing this step (aspiration) correctly, it is still possible to have false negative aspirations at times. This can occur when a bevel is in contact with a vessel wall. During an aspiration test, negative pressure can retract the vessel wall into the lumen of the needle blocking the flow of blood through the needle into the cartridge. To check for false negative responses, rotate the syringe slightly; this will reposition bevels away from vessel walls. This step is encouraged for all injections in which there are greater risks of positive aspiration.

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Repeated penetrations and the development of an inflammatory response may diminish the effectiveness of the local anesthetic agent. Clinicians may also have other concerns such as the development of hematomas and postoperative pain or trismus.

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Avoid delivering too much solution en route to the deposition site. Once at the optimum deposition site, the most important step in the administration of a safe injection is the rate of delivery. Slow delivery of the drug reduces the risk of overdose and complications even if inadvertently injected into the bloodstream after a false negative aspiration.

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The patient's record must include:

1. Date of administration

2. Type of drug(s) administered (both topical and injectable)

3. Injection(s) administered (or area of delivery when topical alone is used)

4. Total volume of drug(s) administered

5. Results of aspiration, recorded as "positive" (+) or negative (-)