Patient Safety for SIJ &

Lumbar Facet Pain

Intervention
Ketut Jayati Utami Dewi
PATIENT SAFETY IN
INTERVENTIONAL PAIN
PROCEDURE
Scope of error
• Human error
• Knowledge based
• Rule based
• Skill based
• Technical problem
• Communication problem
• Characteristic of patients
Types of medical errors commonly seen
• Diagnosis related
• Treatment related
• Competency of staff
Treatment related
• Direct spinal cord injury
• Direct nerve injury
• Dural puncture
• Epidural hematoma
• Pneumothorax
• Infection
• Falls
• Radiofrequency equipment
• Radiation safety
• Medication toxicity
• Allergy
• Patient identifiers
• Anesthesia complications
• Aspiration pneumonia
• Post procedure monitoring
• Communication related issues
• Organization related issues
Sacro Iliac Joint Intervention
Contraindications
• Absolut
• Local malignancy
• Local infection
• Sepsis
• Relative
• Coagulopathy/use of blood thinning agents
• Pregnancy
• Diabetes mellitus with poor glycemic control
Complications
• Procedural and post – procedural pain
• Bleeding
• Infection
• Vasovagal episode
• Skin hypopigmentation
• Subtherapeutic outcome
Prevention of complication
• Fast acting local anesthetic through the ablation needle – wait at least 90 s
• LA + steroid – diminish post neurotomy neuritis
• Small gauge of needle
• SIJ proc – ASRA guidelines 2020 – do not recommend that patient stop
anticoagulant unless there are concomitant bleeding risk (liver & kidney disease)
• Good aseptic technique
• Sterile drape
• Restyletting or flushing the procedure needle with non steroid injectate before
removing it
• Dilute the injectant to a maximum concentration 10 mg/cc
Lumbar Facet Joint Intervention
Contraindications
• Systemic or local infection at the site of injection
• Bleeding diathesis or anticoagulan use
• Allergic reaction to contrast, anesthetic or corticosteroid
• Local malignancy
• Patient refusal
Complications
• Frequent
• Spread of contrast agent into soft tissues
• Increase pain and discomfort
• Intravascular injection
• Complication related to used drugs
Complications
• Serius but infrequent
• Multifidus atrophy
• Inadvertent subarachnoid or ubdural injection
• Hematoma
• Infection
• Tissue burns
• Problem due to RFT in patient who have implanted devices
• Problem due to RFT in patient with spinal instrumentation
Complications
• Serius but rare
• Spinal cord injury
• Nerve injury
• Disc injury
Prevention
• Needle tip direction should be controlled
• Checked with fluoroscopy imaging in multiple views before RFT
neurotomy
• Sensory and motor stimulation
• Deep sedation should be avoided – patient awake
Prevention Strategies for Patient Safety
• Policy and procedures
• Team rehearsal and checklists
• Quality assurance and improvement process
Summary
• Patient safety is an important issue
• Patient error can be catastrophic
• Preventing these errors is the key