Freaky PPD

[OBNURSEHEATHER]

Hello there fellow nurses! I had an interesting thing happen to me and I'm looking for some advice.

Wednesday morning I went for my annual PPD for work. They were scheduled in 1 hour blocks, 3 times during this particular day. Well, I'm not new to the PPD, but let me tell you, this thing BURNED. I'm talking like FIRE. Like someone was cutting my arm up with a hot razor blade. I said a few choice words to the poor person on the giving end of the needle, and her reply was "Gee, everyone's been saying it burns real bad".

So I'm walking around for about an hour, and my forearm still hurts. One of my fellow nurses barges into the nursery (my lovely assignment that day) and says "Oh my god, look at your arm!"

A reddened circle, about 2 inches in diameter, feels like a hard welt, hot to the touch, and itches FEROCIOUSLY! Turns out everyone who got it in this 1 hour block is having this reaction. But it's better by the end of the shift. Only to return for us in the evening, and looked the same when I had it read this morning.

At our supervisors request, we all went to employee health. The first nurse looks at us, tells us she hates to speculate, but she's seen something like this before, and thinks the lady gave us TETorifice instead!!!!! That, or possibly a flu vaccine, cause they keep them all in the same fridge!!! Head of employee health comes in and blows the first nurse off. Tells us it's just a reaction, happens more than one would realize. Not to worry, it's not a + reaction. Tells us to run along.

Turns out one of my coworkers got a PPD after we left, from the first nurse who speculated about the wrong solution. Told my coworker that the other nurse was probably trying to cover, then opened the fridge and showed her how all the solutions are stored together!

So here I sit, 57 hours later, the symptoms remain, but are lessened. Head of employee health said she'd trace the problem, but a few minutes later says they're not required to record lot numbers for PPD's.

I'm sorry this is so long, but does anyone have any clue about what might have happened? What I could do? Where do I go next?

Heather

[codebluechic, ASN, RN]

Is it possible that she injected it too deep? My husband had a false positive once after someone injected the PPD into muscle.

[KeniRN]

I was the PPD giver for my department this year. It sounds as if the wrong solution was drawn up. The tuberculin solution should not burn. Our employee health dept did not require us to record the lot numbers however the one cardinal rule in nursing...CYA...I always record that kind of info for that very reason. My dept is a Primary Care Center so I give PPD every day. The vials that Flu and tetorifice come in look VERY much like the one PPD solution comes in.

I have to double check myself every time I draw up any of these.CYA :eek:

[P_RN, ADN, RN]

Gosh I bet I've given a thousand of the things. I don't remember anyone saying it burned like that.

Try some benadryl creme for the itch.

It needs to go to QA though. It shouldn't stop with Employee Health if they are blowing it off. Something isn't right.

Gosh what if someone had been allergic to the TT or whatever?

[hoolahan, ASN, RN]

Even a positive reaction would not react that quickly.

I say it is one of the following;

a) wrong solution

b) contaminated solution

c) bad lot of PPD

If they refuse to acknowledge that it was the wrong solution, and it sounds like it was, then they MUST report this to the drug manufacturer and as an adverse reaction! Because if it was PPD, then there is something very wrong!

My question is, if the nurse who suggested it may be the tetorifice vaccine knew there was a problem with the storage and mix-up of meds, WHY wasn't the problem corrected? Like putting a colored band on the different vaccines, or better yet having two nurses check the vials, like blood checks. We had several episodes of heparin mix-ups at one hospital I worked with, so a form was developed so that every time a change was made two nurses confirmed the lab results, dose, conentration, etc... NO further errors in heparin drips occured. Drastic, but it worked.

Or, keep the m in different color bins on different shelves in the fridge. Maybe the manufacturers need to know the vials are too similar in appearance. Remeber how the look of the little KCL vials changed when people accidently drew up KCL thinking it was saline to flush heparin locks? We had several incidents where I used to work in CT ICU where certain drugs would show up in different vials, and we always posted a huge warning poster in the med area, to warn people of a new look-alike vial.

Sounds like this never should have happened Heather. At the very least you will need to be re-tested for sure in 3 weeks.

[KRVRN, BSN, RN]

Some sort of follow-up IS definitely in order. Maybe it was a bad lot and had the wrong preservative or something in it. Maybe it was tetorifice or flu vaccine. If several employees complained about the same feeling, then eyebrows should be raised. And if several people have complained, shouldn't something have been looked into THAT DAY before they gave anymore doses?! Sounds like their storage system needs work too. What if you were allergic to tetorifice or flu vaccine, as P_RN said?

I'm remembering something I learned back in school about PPD's. I seem to remember that there is or was a higher strength PPD solution. Like, if what we all get is 1x, then there is also a 10x strength. I just can't seem to remember the details of that or why such a thing would exist. Does anyone else remember hearing anything like that or am I just screwy? And could that have been what was used??????

[P_RN, ADN, RN]

The PPD test (Mantoux) we usually think of is 5 TU

There is also the 2 TU and the 10 TU.

(PPD purified protein derivative)

The best URL I could find is a South African Pharmaceutical Co.'s

http://home.intekom.com/pharm/biovac/t_ppd.html

It does state that the diluent or preservative can cause a reaction.

BUT It still needs reporting. The FDA has a nifty little reporting tool on their site.

[KRVRN, BSN, RN]

Yes! The 2, 5 and 10 IU thing, I knew I wasn't imagining it...

[PJRNC2]

We still record the Lot # for each PPD test given. One year we had an unusually high incidence of ecchymosis at the site (during the annual testing of staff).