I'm ANGRY and TERRIFIED!!

[kwagner_51]

I was at work last night and experiences a dirty needle stick!! :angryfire It shouldn't have happened, but because someone was taught to put a needle at the end of an IV line to protect sterile conditions it did.

I work in a nursing home and we get pts in that really don't need to be there but this is the only way Medicare will pay for the treatments. This pt is in because he has cocci in his blood. he get ampicillin and Gentamicin IV scheduled to run at 10 AM, 11 Am [gent] 10 PM and 11 PM. In between, we are to do the SASH method. He has chronic endocarditis, brought on by valve replacement, defib placement that became infected, CABG, etc.

Anyway, a nurse put a sterile needle at the end of the primary line. I went in to hang the 11 PM gent and was trying to flush the line, but it wouldn't flush. I could see that there was something at the end of the line so I reached down to take it off. I wasn't wearing gloves because I was flushing the tubing. Unknown to me, there was blood in the line and of course, in the no longer sterile needle. If I had been wearing gloves, it wouldn't have mattered. I bled for 10 min. I had to get new tubing and hang the IV regardless of what was happening to me. I got it hooked up, wearing gloves and by the time I was finished, the first finget of my right hand glove was full of blood!!

I read his chart and didn't see anything r/t HIV or anything like that, but he has a BLOOD infection!!!

Why do nurses put sterile needles in the port? what is the reaoning? Isn't that why we wear gloves and use alcohol pads to wipe the ports off?

Thanks for letting me vent!! Any advice would be appreciated!!

[UM Review RN, ASN, RN]

Are you saying that there was a needle in the piggyback port? Maybe it's me, I'm not quite sure I understand what you're saying.

If that is the case, aren't all facilities supposed to have changed to needleless systems by now?

[pricklypear]

No, it sounds to me like someone capped the line between use with a needle in a cap instead of some other type of cap to keep the pt end sterile. I'm sorry that happened to you. Does your facility have a protocol that has you to the ER for a workup? Ours does. They draw blood and screen for typical stuff like HIV, HEP. Hopefully the antibiotic in the tubing took care of what ever was floating around in the blood that was in the tubing.

[kwagner_51]

Are you saying that there was a needle in the piggyback port? Maybe it's me, I'm not quite sure I understand what you're saying.

If that is the case, aren't all facilities supposed to have changed to needleless systems by now?

No, it isn't a piggy back. He had a PICC line [that also came out last night] we just hang the small bags of IV antibiotics. It has a prmary set. In other words, from the tubing in the IV down to where it goes into the PICC line. At the end of the line [where the hub is, was a DAMNED needle!!] The only thing I can come up with is, the cover for the hub got lost and she used a sterile needle to cover the hub. There was blood in the line from where he back flowed before she shut it off. Instead of flushing it, she capped the line with the needle. :angryfire :angryfire :angryfire

Where the Luer Lock collar attaches to the PICC line is where the needle was. Evidently, she has been taught to use a sterile needle if the end cap gets lost.

We DO use needleless systems. Most all of our IV's run to gravity. There was absolutely NO REASON for me to think there could be a needle ANYWHERE on that IV.

Is this a better explaination?

Thanks!!

[UM Review RN, ASN, RN]

I understand now, thanks for clarifying. Regardless of how it happened, I understand your fear and your anger, and I hope everything will come out ok.

You did report to your supervisor, make an incident report, and are starting prophylaxis, right?

[meownsmile, BSN, RN]

She wasnt taught that,, she was just lazy and didnt want to go back and get something to cover the connection. I hope you wrote it up, got yourself your shots and started your blood workup.

I think i would request the facility order some prefilled saline syringes,, so there are no needles to be left like that from a flush.

Im a little concerned to why you are hanging IV piggybacks to a picc line without a pump? Thats a little dangerous too. Always use a pump with piccs and central lines.

[nursemary9, BSN, RN]

More importantly, did YOU go to ER & did you get tested?

Wehave a protocol & they do blood tests, etc.

Did you make incident report--you absolutely need to do this

Mary Ann

[SmilingBluEyes]

I agree w/the above stating you need to follow policies/protocols regarding needle stick injuries. CRITICAL you do this if not already done. Also yes, an incident report is an absolute MUST-----make sure the house supervisor and your manager get copies, as well as risk management and maybe even employee health. I am so, so sorry this happened to you. You are right; it was NEEDLESS!!!!

[kwagner_51]

I agree w/the above stating you need to follow policies/protocols regarding needle stick injuries. CRITICAL you do this if not already done. Also yes, an incident report is an absolute MUST-----make sure the house supervisor and your manager get copies, as well as risk management and maybe even employee health. I am so, so sorry this happened to you. You are right; it was NEEDLESS!!!!

I did file an incident report, but there was/is no house supervisor. There was me and one other RN who knows ABSOLUTELY nothing about anything!! This is a very small Nursing Home. Most of us don't know how to use a pump. After I stuck myself. I washed my hands and put a bandaid on my finger and continued working. I went back down to flush his PICC line and noticed that I could see the actual white line!! :uhoh21: So I got the other RN to take a look. Sure enough it was coming out. I called the MD and got an order for a peripheral IV :imbar I don't have a CLUE on how to start an IV. I only started 2 the entire time I was in school. I asked the other nurse if she would do it and she flat refused!! I called the person on call and asked her what i should do. She tried to get the other RN to do but she continued to refuse.

The other RN called in the paramedics to start it. When they got there she realized that we didn't have the necessary tools for them to do it, and the guy who was going to do it hadn't started an IV in 17 years!! :angryfire :uhoh21: Long story short, we had to send him to the ER to get a SL!! :imbar The lady I called was made aware of the needle stick but was more interested in why the PICC line came out!!

I have had the HIB shots and every other shot required for nursing school. I didn't go to the ER because there was no one there to ok it. I don't think she will be in until Monday. opefully the gent killed what was in the blood in the tubing. Isn't it too early to test for HIV? Doesn't it have to be 6 months post stick?

Thanks!!

[catlady, BSN, RN]

You should have gone to the ER/Occupational Health site IMMEDIATELY! I wouldn't be asking for permission, I would be informing them that I was going NOW. Depending on the level of risk they assess, you might need to start prophylactic therapy--and the sooner the better.

[SmilingBluEyes]

Yes, get to an ED. They can implement the proper procedure/prophylaxis protocol for you. The sooner, the better.

[ERNurse752, RN]

Baseline labs should be done on both you AND the source patient. Find out STAT where you are supposed to go to get this done - there should absolutely be a policy and procedure on this for your facility. You and the patient or the patient's family will have to sign consents for HIV testing. They also test for Hep B and Hep C.

Prophylactic drugs for HIV should be started within two hours of the stick.

It is up to your supervisor to find coverage for you while you take care of yourself. I would imagine to not do this would be a big fat OSHA violation. You also do not have to pay for any of this, it's worker's comp.