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What is Injection Safety Monitoring?

   

Jeff Gadsden, MD. Published by B. Braun Medical Inc.


ISM is the use of objective information from complementary monitoring modalities to guide more informed decisions for needle tip placement and local anesthetic injection to help prevent neurological complications. Ultrasound, objective injection pressure monitoring and nerve stimulation are synergistic and additive and offer the provider with complementary information to get the broadest picture possible.

In modern practice of PNBs, ultrasound is typically used to guide the needle towards the desired target or tissue plane. In conjunction, nerve stimulation is used to rule out a motor response at <0.2 mA, which could indicate intrafascicular needle placement. Avoiding high opening injection pressure (<15 psi) is the last line of defense to avoid an injection into a poorly compliant tissue such as fascicle or against the nerve. The same monitoring process repeats for every subsequent needle reposition and injection.