Re: "10 Anesthesia Technologies: Are They Right for You?" (September, page 42). The nurses at my facility, Littleton Day Surgery Center, in Littleton, Colo., attended an in-service and practice session held by a company selling the jet injectors. We are an ambulatory surgery center and start approximately 200 IVs per month on pediatric, adult and geriatric patients. However, upon review, we have chosen not to use this product because of the following reasons:

• the expense was greater than the risk of our history of IV site infections (none in more than five years!)
• the noise of the injectors was very loud and disturbing;
• the infiltrated site was numb, but the actual injection was still mildly painful;
• many of our patients have fragile skin and the impact of the injectors seemed too powerful and potentially damaging to the tissue; and
• the nurses were not comfortable using a device that does not allow user control (the amount of force/pressure for the injection, for example).

The conclusion was that it's a great idea - but too invasive. Thanks for the article!

Cynthia A. Burciaga, RN, BSN
Director of Nursing and Perioperative Services
Littleton Day Surgery Center
Littleton, Colo.
[email protected]

Overcoming a Child's Fear of Needles
We had a new patient come in, quite young and very much afraid of needles. I explained to him we had a way of taking a blood sample that would not hurt him. He was skeptical to say the least and he stared at me in disbelief. I warned him about the pop the jet injector makes. He jumped a little and said, "Was that it?" I asked if it hurt and he said, "Well ... no!" I told him that now when I actually put in the needle, it shouldn't hurt at all.

I showed him the needle and carefully tested the anesthetized area. I asked if he could tell I could touch his skin with the needle. He said, "I don't think so." So I did the venipuncture and got the blood specimen I needed. He was very proud of his accomplishment. His mother came and said she was amazed that he didn't fuss because he usually fussed terribly with needles. He held up his arm and said, "Look mom! It didn't hurt at all!" She was rather shocked at his reaction and asked if we really had the specimens. I showed her the samples and she asked for an explanation. I explained to her that I had numbed the area with a needless syringe before doing the venipuncture, so the needle did not cause any pain.

The jet injector made a believer out of one young, scared child, and what could have been a tense situation turned out very well. It's a technology that has really made a difference in our practice.

Carl Manion, MD
Clinical Pharmacologist
Oklahoma Medical Research Foundation
[email protected]

Jet Injectors Cut Costs All Around
We switched from conventional IV induction to needle-free jet injectors about a year ago and, while they cost more than regular needles, we've saved considerable money overall, both in direct and indirect costs.

To get staff buy-in for the switch, we trialed the jet injectors to see how they worked and to see if the anesthesia was comparable to the needle - the consensus was that it was better. The more we tried the jet injectors on patients, the more we found they love it.

To convince my administrator that the switch was going to be cost-effective, I didn't do a formal cost-benefit analysis; I did point out that, at the very least, we'd cut our bio-hazardous waste costs, because bio-hazardous waste costs 10 times more to dispose of than regular trash - which is where jet injectors are disposed.

Now that we've made the switch, we've noticed other areas where we save. Before, we had to add bicarb to the bottles of lidocaine to lessen the sting, which meant the lidocaine only lasted 24 hours. Because the lidocaine is dispersed over a broader surface area with the jet injectors, it doesn't sting. So we don't have to add the bicarb, which results in two savings: we don't have to buy bicarb, and we don't have to throw out bottles of lidocaine each day; we just use the 10ml bottle until it's done.

We also use less anesthetic per case, because the injectors disperse the medication over a wider subcutaneous area.

Lastly, we've decreased our liability because there's no needlestick risk.

To top it off, our patients really like it; patients often comment, unsolicited, that they would be more likely to come back to our facility based on the absence of needles alone.

Susan Goodwin, MS, RN, CNS
Nurse Manager
Surgery Center of Edmond
Edmond, Okla.

Drafting a BIS Monitoring Policy
Re: "Maximizing Your Consciousness Monitor" (August, page 65). I just read this article and thought it must have been fate. I have been asked to write a draft of a policy on the use of the BIS monitor. We purchased the BIS monitoring system about two years ago and have recently upgraded to the new sensor. Our health system has both acute care and freestanding outpatient facilities. The BIS monitor is only used in the three acute care hospitals, but inconsistently. We perform all types of surgical procedures except for transplants. A quick verbal poll of anesthesiologist results in the same number of opinions. In order to provide consistency and to actualize the "promised" savings, we are looking for guidelines that can be shared with all of the facilities in our system.

Mary Rippy, RN, CNOR, BSAOM
Manager OR Support & Endoscopy
Fort Sanders
Regional Medical Center
Knoxville, Tenn.
[email protected]