Best new tech of 2013
Another interesting year for pediatric practice has flown by. As of this writing, patients are unable to enroll in the new health care exchanges due to flaws in the web-based registration system. As a consequence, the deadline for implementation of the “individual mandate” has been pushed back to 2014. In the months to come, Congress is expected to negotiate changes to the Affordable Care Act (ACA) or perhaps postpone its implementation. In other words, it’s “business as usual” for those that regulate health care.
Meanwhile pediatricians in the trenches are still providing the best care for children in an increasingly complicated world. Version 2.0 pediatricians will always consider improving their practices by integrating technologies that can facilitate a diagnosis, expedite therapy, or enhance the quality of care provided. This year, I have a bounty of “best” new tech products for your consideration, so let’s get started.
Improving anesthesia for IV starts, and a new “Buzzy” device
According to 1 study, 63% of over 1,000 children surveyed said that they fear the needlestick associated with immunizations.1 Eventually, we all will be immunizing our patients with needle-free, less-pain-producing syringe devices (see “The high-tech practice of the [near] future.” Contemp Pediatr, 2013;30:46-49). Pediatricians can now use a needle-free syringe system called the J-Tip Needle-Free Injector (National Medical Products; Irvine, California) to deliver buffered 1% lidocaine subcutaneously for intravenous (IV) starts.
Buffering lidocaine with sodium bicarbonate (1 ml of 8.4% sodium bicarbonate for every 10 ml of lidocaine) changes the pH of the final solution to 8.0, reducing the sting associated with lidocaine injection.2,3 Both lidocaine and bicarbonate are inexpensive; a 50-ml vial of either medication costs as little as $5. The J-Tip Needle-Free Injector uses a small compressed gas cylinder integrated into each disposable syringe. The J-Tip syringe is filled with buffered lidocaine via a standard 3 ml syringe with a Luer adapter. Once the area is prepped, the syringe is pressed against the skin and the device activates. An audible hiss is heard as the buffered saline is injected at high velocity into the subcutaneous tissue, creating a dime-sized, pain-free zone through which a needle may be inserted. Although the needle-free injection of lidocaine is not completely painless, it is less painful than lidocaine delivered with a traditional syringe fitted with a small gauge needle.4
Children who have sites prepped with EMLA anesthetic cream (lidocaine/prilocaine) must wait a full hour for optimal anesthesia effect, while those using a liposomal lidocaine anesthetic cream (ELA-MAX) must wait a half hour until full anesthesia is achieved. Using the J-Tip Needle-Free Injector, anesthesia is achieved in less than 2 to 3 minutes. The device has also been studied for lumbar punctures in infants and has been shown to be associated with less pain compared with traditional methods of injecting lidocaine prior to the procedure.5 I can envision that the injection of lidocaine into the subcutaneous tissue surrounding a wart prior to cryotherapy is another potential use. It might also provide a reasonable substitute for children who are needle phobic and insist on the application of EMLA patches before subcutaneous or intramuscular injection of vaccines, although it is not intended for this purpose. The J-Tip injector comes in boxes of 25 that sell for $100.
While we are on the topic of reducing the pain associated with injections, there is now a smaller version of the very popular Buzzy device, the Mini Buzzy (MMJ Labs; Atlanta, Georgia), that reduces the pain associated with needlesticks. The Buzzy is a small vibrating plastic device fitted with a cold pack that is positioned “between the brain and the pain”; eg, above the needlestick on the arm. The device saturates sensory nerve endings with cold and vibration, interfering with the transmission of pain. Many patients in my practice request that the Buzzy be used for their immunizations. The Mini-Buzzy costs $39 and is intended for home use by children who receive injections of insulin, growth hormone, or other medications.
MORE ARTICLES IN THIS ISSUE
Preventive health care services, including dental and vision benefits, will now be available under the ACA to millions of previously uninsured children.
Does vitamin D reduce acute otitis episodes in children who are prone to them?
Eosinophilic esophagitis is an increasingly recognized condition in children and adults that may mimic gastroesophageal reflux but that does not respond to acid suppression. Current treatment focuses on dietary modification and topical corticosteroids. However, future studies are needed to better define this disease’s natural history and to identify effective therapies for children and adults.
Efforts to increase the time adolescents spend in physical activity and reduce the time they spend watching television seem to be paying off, according to analysis of data from 3 quadrennial surveys of students in grades 6 to 10.
A new study demonstrates that passive exposure to cigarette smoke increases how much pain children perceive during an invasive medical procedure.