Paperclips for eye exam????

Specialties NICU

Published

Two of my babies got their first exe exam for ROP today on dayshift. In report, the day nurse told me that the Opthamologist said her eye speculum wasn't in her pocket and asked where we kept them on the unit. When she found out we didn't keep any on the unit, she proceeded to fashion one from a paperclip from the nurses' station. She cleaned it with an alcohol swab and rinsed it at the sink before using it. The dayshift charge nurse apparently didn't have a problem with this and my pm shift charge just said "they've done it before".

Am I hopelessly anal??? Is this OK????

Thanks in advance or your views.

P.S. I left the "smilies" out of my post so as not to influence responses (they wouldn't have been smiling).

Specializes in NICU.

hi there...this reply must be so so late. But i would like to share that we also use paperclips during eye exam in our unit. New paperclips soaked in a perfektan endo and rinse by SFI and dry. Though i think it's dangerous but still our ophthalmologists still use it. Sad but true! :(( So far no preemies are harmed by this practice.

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Specializes in NICU, Infection Control.

@benny--I think your unit ought to invest several sets of the real thing, get them sterilized and packaged up real pretty. Then insist that the eye docs use them. Just keep saying "Standard of Practice" until it takes.

jmho

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Specializes in NICU.

@prmenrs yeah your right then. thanks for the link you provided. i will just insist then to our head to be strict in following the standard practice. :)

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Specializes in NICU.

That is frightening. Eye exams are the only thing we do, that I can't stomach. Give me a fresh gastroschisis, any day, but when it comes to eyes ~shiver~ That just made my fear of eye exams increase 10 fold!

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Specializes in NICU, Infection Control.

I'm w/you on that, Teeny! I got very adept @ swaddling the kid, holding his/her head, keeping the binky in and sucrosed, and, most imp't, NOT LOOKING! while the eye doc did their thing. One of them used to tease me: Oh you should see this! No, thanks, I'll pass.

I did know one doc who did very fine eye exams w/o the speculum or the other thing. If he saw anything funky, he'd have me sedate the kid and do a more thorough exam. Loved that guy!

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All,

Inappropriate use of paperclips and nonsterile instruments for retinopathy of prematurity exams (ROP) and the subsequent consequences have been documented in peer reviewed literature. See below listing. Refer to the first study noted for a standard of care for retinopathy of prematurity (ROP) instrument management that has been proposed in the Journal of Pediatrics.

Regarding the use of a paperclip as a medical device for an exam in an NICU for a premature infant, ask the following questions:

1. Where was the paperclip made and under what conditions?

2. What type of metal is used? Is it surgical steel?

3. What happens to the properties of this unknown metal once it has gone through the sterilization process? Does it weaken the material causing a potential break and injury? Does the metal leach?

4. Can you use a piece of metal as a medical device in your hospital that does not have FDA 510K approval and is not an approved medical device? What are the consequences of doing so?

5. What will happen if you have an injury with this device? Is there trace ability? Who is responsible?

RELEVANT SCIENTIFIC LITERATURE:

Hered, R. W. (2004). Use of nonsterile instruments for examination for retinopathy of prematurity in the neonatal intensive care unit. The Journal of Pediatrics, 145, 308–311.

Faden, H., Wynn, R. J., Campagna, L., & Ryan, R. M. (2005). Outbreak of adenovirus type 30 in a neonatal intensive care unit. The Journal of Pediatrics, 146, 523–527.

Long SS. Screening examinations for retinopathy of prematurity (ROP) – Safety first. Journal of Pediatrics. 2004 September; 145:2A.

Landon Mawdsley E, Burton S, Garcia-Houchins S, Frank K, Singh J, Gerber S, Myers P, Erdman D, Cromeans T, Lu X, Marcinak J, Weber S. Control of a Human Adenovirus Type 19 (HAdV-19) Outbreak in a Neonatal Intensive Care Unit (NICU); Oral Abstract Presented at: Infectious Diseases Society of America Annual Meeting; 2010 October 22

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Specializes in NICU, Infection Control.

Thank you for that reference!! Let's hope it helps settle the issue! I love when someone comes up w/documentation that something we think "just doesn't make sense" (like using paper clips as an eyelid speculum) really isn't a good idea!!! And tells you why. :yeah:

No more paper clips!

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Specializes in Retired NICU.

:smackingf OMG! In nearly 33 years I've never seen that. That is very scary.

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