Needle stick injury

[Blueorchid, ASN, RN]

Never one to do things halfway- the second night off orientation I manage to stick myself with a 21 G butterfly needle. I was drawing an ABG on a patient that required multiple measures of sedation- he'd had Haldol, Ativan, and I'd been watching my Precedex gtt with a tech at the bedside holding his leg as a final safety measure. Of course the first two times I feel the pulse and he doesn't move- we're short on staff that night so when the tech is called for a transport I look at prioritizing and give him the chance to leave...the guy hasn't been moving right?

Wrong!

Third time's the charm. I'd gone into the skin, pulled back to the point that the needle tip was just under the skin when this guy kicks his foot straight up and I fall forward to catch myself. The needle goes back through his skin and nicks mine. (And I was wearing gloves!) I'd never drawn a flash- I bled the wound as soon as I saw it and washed my hands multiple times before talking to my charge nurse.

Blood has been drawn, consent was given, and so far I know he's HIV negative. But the guy has been incarcerated multiple times before and has lots of tattoos. I get to find the results for Hep C on Monday but I already feel like he's high risk. Any ideas on whether or not they would encourage me to take the meds anyways?

This is terrible. Everyone on my floor who found out has been super nice. I've even talked with someone who took meds for a HIV positive patient and she's offered to help if I need it. But I think the worst part is the waiting. I called my boyfriend at 8 this morning and burst into tears at a coffee shop when it all finally hit me. I'm really easy at thinking worst case scenario. He's HIV negative but I could still convert...and the guy has a lot of risk factors but I know I don't know anything for sure. And I haven't told my parents yet because I want to wait till Monday, I know how they get and I don't want my mom to go around lamenting that her daughter's going to die- they have enough on their plates as is. Needless to say it sucks.

Support would be greatly appreciated and any advice/opinions as well. Thanks.

[BonewaxRN]

It was my very second day working as a new nurse, and I had to give insulin to a young man who had been admitted to the ICU with fever of unknown origin. He appeared to have several indicators for high-risk behaviors. He was so thin that the little abdominal fold I pinched up for the subQ injection wasn't enough to keep the needle from poking through him, into my finger. He just looked at me and said, "oh, honey."

That rang in my head the whole time as I was bleeding the puncture and washing my hands. Oh honey, indeed. He gave consent for testing and eventually everything turned out negative for me after repeat testing over a period of a year. I was never started on anti-virals.

Something to give you hope is that it was a small-bore needle without appreciable blood in it. Any stick is dangerous, but large-bore needles with aspirated blood are the ones associated most with HIV transmission to healthcare providers. I am not sure about hepatitis.

It's frightening and it wears on your nerves for quite a while, until you've passed repeat testing. You have my sympathy and best thoughts.

[Frozen08]

Sorry to hear about your first needle stick. I too had a needle stick but mine was on someone seropositive for Hep B and C.

My advice is to seek out a primary care doc or find an infectious disease doc willing to work without a referral. Your employee health is most likely inexperienced at dealing with actual infected needle stick accidents; they don't usually happen that often at individual facilities (unless you happen to work at a huge quaternary care facility).

If your exposure was Hep c or HIV positive make sure you have your primary care doc involved right away. I didn't think much of it at the time, but I was advised by employee health to just stick with monitoring. Looking back (i did not become infected) it was stupid to not seek PCP consultation.

As of now there is no effective prophylaxis treatment for HCV (talk with your doc though, it might be worth trying ribavirin and interferon as a hail Mary if your stick is HCV positive). I assume that you have HBV vaccination, if not there is passive immunity available.

[sethmctenn]

Sending you prayers for comfort now and the best news possible Monday.

Seth

[NnSweets]

Sending prayers...But if you do the recommended prophylaxis that they offer your chance of contracting anything is honestly very small, even if they decide not to give you anything. You are most likely safe. It happens to the best of us. You did the right thing by letting someone know right away.

[demylenated, BSN, RN]

I'm sorry this happened, and it is very frightening. However, just to give a little encouragement, the chances of attaining a disease from a needle stick is actually very minimal, even if the patient is positive (less than 1% for AIDS, 10% for Hep C, and 30% for Hep B). That is in the poorest of condition (blood, blood, not bleeding the wound, not washing immediately, ect). I work with drug addiction. I start IVs every day on nothing but drug addicts. Terribly, I don't often wear gloves like I should (I *hate* starting IVs with gloves on). There was one guy that I started an IV on, and I WAS wearing gloves. I managed to get blood on my leg (he was a bleeder, and bled through the IV until I put the cap on), and managed to get blood above my glove. He joked with me, "Good thing I don't have the virus, huh?" Sad thing is, 2 days later, our routine labs FINALLY came back, and he WAS positive for HIV. I was honestly more saddened by having to tell him the news than I was my chances of getting the virus (granted, I had intact skin and it was not a needle stick).

I know the statistics don't take away the anxiety, but I hope they bring some comfort.

Good luck.

(BTW, my numbers came from: http://www.ccohs.ca/oshanswers/diseases/needlestick_injuries.html)

Oh, and the physician I worked with had gotten blood on himself as well. When I informed him of the blood after the labs came back, he said not to worry, that the chances were so slim (mainly because my skin -and his- was intact, so no blood-blood), and that taking the antiretrovirals would likely do more damage (now, had it been a needle stick where there was blood in the needle, I would have made a different decision).

3 years later, I am negative...

Said a little prayer for you... if you don't mind, will you keep us updated?

[misscherie]

Great advice here from the other nurses . As the others have said, try to stay positive until you do find out and chances are, you will be just fine! Even though the powers of the mind can make us imagine all sorts of worse case scenarios, it often will be okay. I have my fingers and toes crossed for you, please keep us in the loop! :redpinkhe

[chybabe]

I understand how you feel. I had an accidental needle stick some years ago as a HIV-AIDS nurse while administering SubQ heparin to an AIDS patient. I had to go through the intense anti-viral meds with constant blood test for 1 yr until i was cleared. As stated above, the chances of contacting anything is very slim especially with small-bore needles but i know i was just as anxious as you were. Relax! You'll be alright :)

[JSoupyERnurse]

A needle stick is always a scarey and sobering experience, but they do happen unfortunately. Okay, so that aside, the risk is so minimal that you will contract anything from the stick and it sounds like you did everything right. Having had a needle stick injury myself, I know exactly how you feel and as a new nurse when the incident occurred, I worried myself sick even though I knew the risk was low. Hang in there. The chances are extremely great that everything will be just fine.:)

[CodyRN]

Also, I THINK for HIV...the size of the "viral load" will depend on whether or not a person contracts it. If the viral load is small enough, I don't think the person will actually get anything.

[Blueorchid, ASN, RN]

Well, to all those who wanted to know everything came back negative :) :) :)

After an unpleasant weekend wondering what to do next I went down to employee health and was told I was extremely low risk for any kind of transmission in the future. I'm still going to get tested for peace of mind but for now I'm going to put it out of my head.

Thanks everyone for the well wishes. I consider this one my "freebie" and will try to be more careful next time.

-Blue

[demylenated, BSN, RN]

That is GREAT!!