insulin pens, safety needles, and needsticks

[LanaBanana]

Last night I had my first needlestick injury and it was from using our new "safety" needles for the insulin pens, particularly the Regular insulin. I had a pt s/p double AKA and recent abd surgery from a trauma. I attempted to give the injection on the side of abdomen but he refused saying the area was too tender and everyone else had been giving the insulin in his upper arm. Normally I stay away from there because of the stories I'd heard about going through the skin but it was the only place he would take it. So I either give insulin there or don't give it at all to someone with a FSBS of 319. I squeezed up enough of his arm that I thought was enough and gave the injection with the safety needles. Next thing I know, I feel it stick my finger and and it's bleeding into my glove. I quickly left the room, squeezing my finger to make it bleed and washed my hands. Filed the appropriate incident report, ordered labs for the pt, and then saw employee health today. The nurse in employee health said there's been a significant increase in needlestick injuries since switching to the new pens. I understand that they are not advised for use in the arms, but in this situation, I either gave it there or the pt would not get the med (which is the choice I will make next time.) I also know of a nurse that was stick while giving it in the abdomen. On certian pt's if you are not holding an area of skin tight, you can't get the needle to activate and it also more painful to be pushing down on the belly of a little old lady. I understand the need for advances in technology, but is this an advance. I personally feel like I can protect myself better from a needle that I can see than from one I don't see. After this happened, I also realized that I don't actually know how long that needle is.

What do you think? Do your facilities use the pens? Is the increase in injuries just an initial adapting phase?

On a good note, I did find out that the pt was neg for HIV, Hep B and C. I got my baseline labwork and will get it again in 6 months.

[NursingAgainstdaOdds]

Yikes - that's scary. I've never used the pens you are referring to.

One safety issue which sticks in my craw is medicine pens pts use at home, where one dials-up the dose. The needles are designed for patients to use at home, and actually screw on and off, and when I have to administer the med they are an obvious safety issue. Whenever possible, I have the pt continue to self-inject, but I still have to take care of the sharps usually, unless I can track down a small sharps container.

[EmmaG, RN]

I think I know what you're talking about; one of the hospitals I contracted with used them. They were awkward, to say the least. After several attempts, I could see where it was leading (i.e. I was going to poke myself), so I used the normal insulin syringe, drew up the dose and gave it. After being there for 3 months (and they had been using them for a bit before that), the staff was still having difficulties with those needles. I'm not sure if anyone had been stuck, though.

[AmericanChai]

I am not a nurse yet and can't comment on giving shots. I am, however, a patient who gets allergy shots. Our clinic recently switched to the new saftey syringes which are probably similar to what you are using for insulin. I think they are the diabetic needles-- very tiny and thin. I noticed that they hurt a lot. The regular needles produce little or no pain. The nurse who gave me the shots said a lot of patients had complained about the new needles hurting more. I noticed at last week's shots they were using the old kind again.

[EmmaG, RN]

I am not a nurse yet and can't comment on giving shots. I am, however, a patient who gets allergy shots. Our clinic recently switched to the new saftey syringes which are probably similar to what you are using for insulin. I think they are the diabetic needles-- very tiny and thin. I noticed that they hurt a lot. The regular needles produce little or no pain. The nurse who gave me the shots said a lot of patients had complained about the new needles hurting more. I noticed at last week's shots they were using the old kind again.

I've had patients tell me that about 'safety' needles and also the retractable lancets used for accuchecks.

[LanaBanana]

Yikes - that's scary. I've never used the pens you are referring to.

One safety issue which sticks in my craw is medicine pens pts use at home, where one dials-up the dose. The needles are designed for patients to use at home, and actually screw on and off, and when I have to administer the med they are an obvious safety issue. Whenever possible, I have the pt continue to self-inject, but I still have to take care of the sharps usually, unless I can track down a small sharps container.

those are the pens I'm talking about except the needles we use are kind of an auto-inject thing where you never see the needle and have to press it in to the pt to activate it, then the needle goes in and you press down the button to inject. When you let up on the pressure the cover automatically covers the needle. They can be used with different needles for pt's at home but the only ones the hospital gets is the safety one.

[ckc6977]

We use the insulin pens you are refering to. I have never had an needlestick injury and do not know of one on our particular floor.

I personally have mixed emotions about the pens. I find myself pushing the pen into their arm than I normally would if I were using an insulin syringe.

The pens typically have smaller (length & diameter) needles.

Sorry this happened to you; however, I'm glad the pt's bloodwork is good so far!

[oneLoneNurse]

I find myself pushing the pen into their arm than I normally would if I were using an insulin syringe.

The pens typically have smaller (length & diameter) needles.

It seems that I push the needle into the patient's arm to get it to retract. After having it not retract several times in the past. I have not heard about a stick, but I can see that that might happen when we are expecting the needle to be retracted.

Sorry to hear about your stick, but glad to hear the labs are good.

[Sherese3]

I have a patient who recieves Byetta for diabetes. It's supplied in one of those dial up pens. My fear is a needle stick because you screw on the needle, give the injection and then it has to be recapped to remove the needle. Because I'm affraid of sticking myself I use a pair of hemostats to remove the needle before putting it into the sharps container. I don't know if there is something else he could get instead that would be safer. I think the pen is more for someone who is giving themselves an injection. But they still risk sticking themselves because of how this pen is manufactured.

[oneLoneNurse]

I have a patient who recieves Byetta for diabetes. It's supplied in one of those dial up pens. My fear is a needle stick because you screw on the needle, give the injection and then it has to be recapped to remove the needle. Because I'm affraid of sticking myself I use a pair of hemostats to remove the needle before putting it into the sharps container. I don't know if there is something else he could get instead that would be safer. I think the pen is more for someone who is giving themselves an injection. But they still risk sticking themselves because of how this pen is manufactured.

Recapped, that does not sound safe.

[RanieRN, MSN, RN]

The hospital I work at started using the insulin pens a couple months ago and so far there's universal dislike for them. While we've been fortunate to not have anyone stick themselves, there's been concern about if the patients are actually receiving the correct dose. Many nurses have noted insulin being on the surface of the skin after administration despite following the directions. And many don't like that we have to press so firmly into the patient either.

[shellsincanada]

I have a patient who recieves Byetta for diabetes. It's supplied in one of those dial up pens. My fear is a needle stick because you screw on the needle, give the injection and then it has to be recapped to remove the needle. Because I'm affraid of sticking myself I use a pair of hemostats to remove the needle before putting it into the sharps container. I don't know if there is something else he could get instead that would be safer. I think the pen is more for someone who is giving themselves an injection. But they still risk sticking themselves because of how this pen is manufactured.

They do make this device to remove the needle you dial on. You screw it on the uncapped need and then press a button to eject it. There is a pharmacy that supplies them for us - not sure of the name.