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| Battle Creek Health System |
| Researchers suggest needles used on kids are sometimes too long |
| Date : - 03/10/2008 |
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New research suggests that federal guidelines on the length of needles used to vaccinate children could put some kids in danger of injury.
"Based on our findings, the CDC [U.S. Centers for Disease Control and Prevention] should alter their guidelines," said study author William C. Lippert, a graduate student at Tulane University School of Public Health and Tropical Medicine.
However, a Vanderbilt University pediatrician questioned whether new guidelines calling for shorter needles are needed, since the nurses he works with rarely experience problems with immunizations.
Childhood vaccines are typically given through intramuscular injections, often in the thigh (for young babies) or in the shoulder (for older children). The injections "deposit" the vaccine in the muscle, Lippert said.
"These injections are given this way to keep irritation and inflammation at a minimum," Lippert said. "Studies have also shown that these types of injections are more readily absorbed by the body and produce a better immune response."
It's important to make sure that the size of the needle is appropriate for individual kids, Lippert said. "The problem is that if the thickness of the needle becomes too small, the needle doesn't penetrate the skin as well and tends to bend. This bending will sometimes cause the needle to break."
Overpenetration is another problem, although it doesn't get as much attention, the study authors wrote. If the needle travels too far into the body, it can strike bone or break off from the syringe.
In the new study, published in the September issue of Pediatrics, researchers used MRI and CT scans to study the thickness of fat tissue and muscle layers in 250 children aged 2 months to 18 years.
They reported that federal recommendations about the lengths of needles don't take into account the bodies of children. Nearly four in 10 babies under the age of 1 would suffer from overpenetration of needles if they got injections in the thigh with the size needles that are typically recommended, the study said. One-inch needles are also recommended, and they'd cause overpenetration 11 percent of the time, according to the study.
Patients who got vaccinated in the shoulder with 1-inch needles would have overpenetration 61 percent of the time, the study reported. For two other recommended needle lengths, 5/8-inch and 7/8-inch, the rates of overpenetration were estimated at 11 percent and 55 percent, respectively.
The study authors recommended that the guidelines be changed to support the use of shorter needles in many cases, depending on the gender and weight of the child.
Dr. Joseph Gigante, an associate professor of pediatrics at Monroe Carell Jr. Children's Hospital at Vanderbilt, spoke to five nurses, and they all reported that "it's incredibly uncommon to have problems associated with the injections," he said. "Obviously, they hurt, but I don't know that changing needle length will change that."
The study does raise questions, though, Gigante said. He suggested that further studies should include interviews with medical staff who do immunizations to see how often overpenetration actually occurs.
** FRIDAY, Oct. 3 **
** Trying to get back in the game too soon can undo benefits of surgery, study says **
Despite the desire to return to athletic activity after hip or knee replacement, patients tend to reduce their activity following their surgery, researchers say.
In a study published in the October issue of The Journal of Bone & Joint Surgery, researchers reviewed the latest data on athletic activity after joint replacement.
Hip and knee replacement surgeries are very successful in relieving pain and improving function in people with arthritic joints. Pain relief has traditionally been the primary reason people consider joint replacement, but with the aging of the baby boomer generation, many people are also looking to improve their joint function.
"Baby boomers have lower tolerance for discomfort and disability if they are involved in athletics," Dr. William L. Healy, an orthopedic surgeon at Lahey Clinic in Burlington, Mass., said in an American Academy of Orthopaedic Surgeons news release. "After joint replacement, they often want to be able to keep up the same level of sporting activity that they enjoyed in the past."
But there is evidence that participating in strenuous athletic activity after joint replacement can cause stress and wear on the new joints, leading to inflammation, fluid build up, pain, and the wearing out of the artificial joint.
Since past research on sports and total joint replacement is lacking, it is still not clear how much activity should be recommended following hip or knee replacement.
"We need to keep in mind that surgeons and patients often assess the success of joint replacement differently," said Healy. "Surgeons look at pain, function, and survivorship, and whether the patient needed revision, while patients consider their pain and activity. If the joint allows them to play their favorite sport without pain, they may not be concerned about needing an additional surgery in the future."
People who have had a knee or hip replacement and want to play sports should train for the sport, build their back, hip, and knee strength, and keep in mind the potential risks of activity after the joint replacement.
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| Reference : - www.bchealth.com |
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