NavaClick is a new delivery system for neurotoxin. Many will sympathize with the problems associated with traditional methods of preparing and delivering neurotoxin to patients. Those of us who have been doing neurotoxin injections for years have likely found a system that works, which may not always be the simplest or most accurate. The most common inconveniences surround reconstitution—getting the toxin in a syringe without dulling needles—and the inconsistencies of human error when injecting.

NavaClick is a system that provides answers to these problems and more. The system includes low-dead-space vial adapters that will fit any neurotoxin bottle. The entire system is luer-lock based, so reconstituting and preparing for delivery is totally needle-free. The star of the system is a metered-dose syringe that delivers exactly 0.02 ml per advancement and is more accurate than the lines printed on the syringe. The syringe also has an audible click with each advancement and a tactile sensation that tells when the advancement has occurred. The needle provided with each syringe is 33-gauge and extremely sharp, but better yet, the coating on the needle allows the provider to perform the entire treatment, regardless of the number of injections, with improved comfort to the patient.

I begin all my injections by explaining to my patients why they might hear a subtle click. Then I mark the areas of aggressive movement and do not have to make the patient move again during the treatment. I always explain that, based on the clicks, I can make their treatment plan very specific and reproducible for myself or anyone in my office to follow. It’s also easy to adjust their treatment plan based on their outcomes. Finally, I pass the cost of the system along, and they have no problem paying for the improved experience.

I must confess. I have always prided myself on being a good injector, but I am convinced that NavaClick has made me a better injector. Because I am doing the entire treatment with a single, metered-dose syringe and needle, I am much faster, and I am extremely accurate.

Now, this is an “aha” moment. I am 59 years old and wear readers. I do not need to look at the syringe because I can hear and feel every advancement. I can focus on the level of my injection—dermal or intramuscular—and watch the injection site without interruption. Even better, because I do not need to watch the lines, I can do the full treatment from one side of the bed.

Creating less waste is a surprise benefit. The whole system ensures less neurotoxin waste, especially due to over-injecting. I am also throwing far less waste into my trash and sharps bins.

The patient data from the institutional review board has not been completed, but I will summarize the obvious subjective findings. With very few exceptions, patients experience less discomfort with the NavaClick, and there isn’t any crunching. It is also the consensus that there is less bruising. Now, let me be clear: That is less comfort and less bruising, not the complete absence of the two. I have always required ice with my treatment, but now I do not.

The initial finding as we track our progress is that our touch-up rate is significantly reduced with the accuracy of the device.

I realize changing one’s routine can be frustrating at first, but I promise it is worth the effort. I am more efficient, more accurate, and less wasteful. Patients are much happier and do not dread their treatment.

In a matter of minutes with a nonsterile demonstration, most injectors—regardless of their experience—understand the technique and see the potential benefits. If an injector is comfortable with a 1-cc syringe, there is no significant learning curve.

However, I found from my own experience and others I have worked with, including my midlevel injectors, there is an adoption curve. When a provider is so accustomed to doing anything a certain way, some adjustments are required for the new way to become as comfortable as the old one. I recognized this when I started with the institutional review board to obtain patient feedback and user input. We only enrolled patients with previous toxin injections, so first-time patients were injected using our old technique. This made us go back and forth, which slowed my ability to adopt the NavaClick. When I was approximately 20 patients into the study, I no longer had to think about the differences, and it became second nature. Now that I am exclusively using NavaClick, it is my new routine, and my staff will not go back. They love it.

Providers have all learned to treat with various reconstitution dilutions, so this may be a source of confusion. NavaClick was designed for a 2-ml dilution, but with minimal effort and the provided chart, any dilution can be used easily. Basically, it comes down to five clicks equal every 0.1 ml marked on a 1-cc syringe.

My take-home message is to give yourself five to 10 patients in a row using NavaClick without going back and forth and you will find your own way to improve your efficiency and accuracy.

To view the full article by Kevin Keller, MD:

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