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Discussion

Freaking out about needlestick

Today I had a patient that was brought to the ER following a heroin overdose. She was extremely combative after being given Narcan. While I was trying to place an IV, she suddenly jerked her arm back and I ended up sticking my hand with the contaminated needle.

She refused to give consent for an HIV test. With her history of IV drug use, I am freaking out. I am also pregnant and am so worried about the potential exposure to my baby. Has anyone else ever experienced a similar situation where a patient refused to consent to an HIV test following a needlestick? I could really use some advice and encouragement right now. I can't believe I did this. I feel so stupid and I'm so mad at myself :cry:

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    Did you follow your facility's needlestick protocol?

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    I think it's a shame she is allowed to refuse.

    Follow the protocol and know that even under these circumstances, your odds are still far in favor that you will be fine.

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    • Author
    Did you follow your facility's needlestick protocol?

    Yes. After cleaning the wound, I reported it immediately and received PEP within an hour.

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    At my hospital, the patient can't refuse. They are tested if there is a needlestick incident.

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    • Author
    At my hospital, the patient can't refuse. They are tested if there is a needlestick incident.

    I really wish my hospital allowed that, especially when the source patient is high risk. Just like any other procedure, patients always have the right to refuse the blood draw. If they do, we can still test them for HBV/HCV if the lab already has previously drawn blood, but we require informed consent to run an HIV test regardless of the situation.

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    Testing the patient is not helpful - in fact it can be counterproductive

    If it is a high risk injury (ie large bore needle used to withdraw blood), it is worth staying on PEP even if they are negative because they could be in the window period (and especially infectious)

    If it is a low risk injury, management won't change if you know they are positive, but you will worry needlessly until you are confirmed negative at 3 months post-exposure.

    It sounds as though you are in the US. Note that the last time anyone got HIV at work in the US was in 2008 (And the last case before that was in 1999)

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    OK- purely hypothetical.

    Unrelated to this case.

    Legalities and ethics aside.......

    Why not steal some blood and have it tested?

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    • Experts
    Today I had a patient that was brought to the ER following a heroin overdose. She was extremely combative after being given Narcan. While I was trying to place an IV, she suddenly jerked her arm back and I ended up sticking my hand with the contaminated needle.

    She refused to give consent for an HIV test. With her history of IV drug use, I am freaking out. I am also pregnant and am so worried about the potential exposure to my baby. Has anyone else ever experienced a similar situation where a patient refused to consent to an HIV test following a needlestick? I could really use some advice and encouragement right now. I can't believe I did this. I feel so stupid and I'm so mad at myself :cry:

    Sending good thoughts your way. Try and concentrate on the very small risk of contracting HIV from a needle stick, even with a HIV positive patient. Wish I could think of something to take the worry and stress away, but all I've got is to remember that even if the absolute worst happens (which is highly unlikely anyway), that HIV is not a death sentence anymore and worry will not change anything. It will only stress you and the baby. Take deep breaths and try to relax (easier said than done, I know.)

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    The Patient Bill of Rights & Responsibilities should force Ms. Doper to give consent. Have a lawyer review the facility/state policy.

    In the meantime, follow your obstetrician's recommendations.

    [h=1]I was in the same place 33 years ago as a new grad. Pregnant and stuck myself with a needle contaminated by a drug user.

    MY OB prescribed IGG and son turned out fine. Best of luck with this.. your facility should be protecting YOU , not the drug user.

    [/h]

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    Sorry to hear this God bless you have faith in God! I had a scare too couple years ago as a CMA but the patient wasn't HIV positive and thank god I didn't get any blood in my eyes. Anyways this is one of my biggest fears on pursuing nursing :( God bless

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