Reuse of lancets, school age child?

[linda1959]

Hello,

I am doing a clinical practicum with a school nurse. We have an 8 year old who tests 2-4 times a day at school. She was told by her diabetic educator that she can reuse the lancets for three days. The mom is insistant we follow this.

When we checked with the educator, she told us that while "best practice" is to change each time, they do tell their patients that they can reuse them until they are dull, for financial reasons. BUT, she will not send us an order to that effect, because it is against nursing standard of care. She says that we should change them at school, but the patient doesn't have to at home.

We think this is confusing for the student. As well, the mother is refusing to provide us with enough lancets to change each time at school, insisting we use one for three days.

Our only recourse is to request the educator send us an order that "at school, lancets need to be changed each time" which might then force the mom to provide us with what we need. This is still a sticky situation, because mom has told us she does not care what the educator tells us---she is the parent and we are to do what she says.

Any opinions?

Linda

[RN1989]

I would tell her that the liability is too high for you to do this and you are personally responsible for you license and actions. If she insists, then tell her that she needs to come to school and take care of this child so that you guys don't have a part in it. I can just see this kid getting an infection from this and you guys getting the blame.

Unfortunately while teaching diabetic ed classes this past year, I came across a CDE that told people the same thing. She is a diabetic and she told people that she knows that she washes her hands well before she sticks herself so she feels comfotable reusing lancets. She did tell the people the risk involved but said it was up to them. Some of the pts in the class verified that other CDEs had told them the same thing.

Make sure you guys get some documentation to cover your butts. Standards from different nursing/medical organizations, infection control etc. This will probably have to be taken to the district level and get worked out by the head honchos

I would refuse to do this. If the district wants to comply with the mother's wishes - they need to find someone to do it and not involve you guys.

[dansingrn]

Actually, reuse of lancets is a very common practice. The newer lancets that are only 30 or 31 gauge make an extremely small puncture, as opposed to the much larger lance produced by the large lancets of the past. The cleanliness of the skin that the lancet passes through is much more important than the issue of one person reusing his own lancet.

The Children With Diabetes website http://www.childrenwithdiabetes.com/ (a very important, comprehensive resource for families of kids with DM) posts a reader's poll that shows 63% of respondents reuse their lancets.

In our pediatric endocrine practice, we see over 300 newly diagnosed kids per year and follow almost 2000 kids with DM. I have never seen an infection on a finger from lancing. I promise I'm not trying to be argumentative here, just sharing my experience.

I definitely recommend changing needles for each and every insulin injection, as well as thorough, immaculate skin prep before inserting an insulin pump catheter. But as far as lancets, not a problem.

Diabetes Health offers the following on this topic: http://www.diabeteshealth.com/read/2005/05/01/4139.html

[blondy2061h, MSN, RN]

I reuse lancets on myself endlessly. Your jaw would drop if I actually counted and told you how many times. Let's just say that 3 days is tame. I also don't use alcohol wipes. It IS the American Diabetes Associations recommendation that hand washing alone is sufficient.

[RN1989]

This may be the "standard" that people are going to, but it is not appropriate infection control. As a licensed professional, I will NOT put my license on the line by doing this. What a person chooses to do to THEMSELVES is one thing. But a licensed professional has a responsibility to the public to uphold standards of care when caring for others - PERIOD.

If it is considered OK to do this, where do we draw the line at reuse of of other one-time use sterile/aseptic products? Sorry, but this is yet again another indication of money issues compromising the integrity of nursings/medical standards.

[truern]

I'm diabetic....I wash my hands well before I use my lancet that has probably been used 2-3 dozen times before it gets dull. Mine is tiny and makes the most miniscule puncture as my meter only uses a tiny drop for testing. The lancet retreats back into the lancet holder and is not out in the open for everything to contaminate it.

[blondy2061h, MSN, RN]

The child is testing her own blood sugar using the technique she was taught by her diabetes educator. It's not you that's doing it.

[dansingrn]

This may be the "standard" that people are going to, but it is not appropriate infection control. As a licensed professional, I will NOT put my license on the line by doing this. What a person chooses to do to THEMSELVES is one thing. But a licensed professional has a responsibility to the public to uphold standards of care when caring for others - PERIOD.

If it is considered OK to do this, where do we draw the line at reuse of of other one-time use sterile/aseptic products? Sorry, but this is yet again another indication of money issues compromising the integrity of nursings/medical standards.

The take-home message in this particular point is that there is no infection risk in a patient re-using her own lancets.

I am certainly sympathetic to the legal concerns of nurses. After all, I'm a nurse! But in the case of re-using lancets, a nurse's license is simply not "on the line."

There are many issues at stake with diabetes in the school setting. As one who works at the national level advocating for our kids with diabetes, I assure you that this particular topic doesn't even make the list. Teaching the reuse of lancets is taught not because of poor standards, but because the evidence supports that it is safe, reasonable care.

This may be off topic some...and its not really my point...but to answer the above post about "drawing the line at reuse of other onetime use sterile products - we see examples of this in practice. Children with spina bifida perform clean bladder caths daily. In the hospital setting, this is a sterile procedure. The literature shows that in this population, clean cath is an appropriate and safe procedure. I'm just saying, you have to look at the big picture, not just assume something is bad practice.

[classicdame, MSN, EdD]

I reuse mine multiple times. However,if it bothers you, take the top off the lancet device and wipe the needle with an alcohol wipe. I do believe the data backs up the practice of re-using the device.

[linda1959]

I really appreciate all the responses.

blondy2061h - If you have a link for your comment that the ADA recomends handwashing alone as sufficient, I would appreciate it. The infomation I found from the ADA states that regarding Lancet reuse, the patient should consult their educator-http://www.diabetes.org/rg2005/meters.jsp

dancingrn - thanks for the link for the comprehensive site used by families.

For the moment, this is what we've decided to do.----

There is a lot of anectodal info on forums regarding resuse of lancets. But I have not found any "official" site (ADA or Lancet company site" which recommends multiple use. As well, I am in NJ, and the NJ BOE Standard for the Care of the Diabetic at school states that the lancet must be a one-time use type.

I can understand the educator telling the family they can reuse. But based on our inability to find any documented info for re-use, and our state standard is not to, we don't feel comfortable re-using.

We explained to the child and mother that while she may re-use at home, we need to replace each time at school "because it's the school rule". The educator backed us up and asked the parent to provide us with enough lancets at school.

As well, we will not ask the student to replace the lancet each time. We will do it for her at the end of each testing so it will be ready for her when she comes back. This will also cut down on the amount of time she is in our office, which allows her to get to lunch and back to classes quicker.

At the moment, everyone is content with this plan.

Thanks again for all the input, and any other perspectives are still welcome!

[blondy2061h, MSN, RN]

Ugh, I definitely remember reading it, but I can't find it.

Here's something interesting though:

http://www.childrenwithdiabetes.com/dteam/2000-06/d_0d_4x1.htm

[dansingrn]

Blondy -

Thanks for the link. I teach soap and water, alcohol wipes if water isn't available. The main point here is to get traces of carb off the finger. Instant hand sanitizer kills germs, but does nothing to get rid of traces of carb. Germs are far less an issue in BG testing than inaccurate readings from carbs left on fingers.

We sometimes see parents who scrupulously scrub their toddlers fingers with an alcohol wipe before testing...toddlers who haven't touched food since the last hand washing. But the parents haven't washed their hands before reaching in the vial and fishing out a test strip. Now the strip is contaminated with the carb residue on the parent's fingers. Another culprit for inaccurate testing...retesting after treating a low without rewashing hands ("I just washed them a minute ago before I ate 'blank' to treat my low!"). Now the BG looks sky high from the residue on the finger...and the BG might still be low!