re-used IV needle

[LibraNurse27]

Hi all,

I am wondering about infection/sepsis risk from IV insertions. I always clean the site, avoid palpating after cleaning and if I need to try again I of course get a new catheter. For some reason today when starting an IV on a patient who was a hard stick I inserted, did not get blood return at first and wanted to withdraw the needle a little bit to re-insert at a slightly different angle (with IV still under the skin) but accidentally removed the needle completely and then re-inserted with success. I am now paranoid that by essentially inserting a catheter that had already poked through the skin to cannulate the patient's vein that I could introduce bacteria into the patient's blood stream. I did some research and sepsis from PIVs is pretty rare but still so worried. any expert opinions? I will make sure this never happens again.

[broughden]

It can happen because you can not render skin sterile...you can only reduce the resident bacteria count on the area in which you are performing the venipuncture..They have also discovered that bacteria is not only on the surface layer of skin but in the other layers as well.

What I think Hherrn is asking is how resticking with the same needle in the same prepped site, seconds apart, is going to introduce more bacteria with the second stick than the original stick?

Unless you removed the needle and then wiped it on the floor before attempting the second stick, what has changed that introduced more bacteria?

[CBlover, BSN, RN]

I always used to insert once, if I missed that needle went right in the trash. I recently noticed nurses trying 2 or 3 times with the same needle. I was like WHAT. I couldn't believe it.

[cleback]

Because the wipe you do when inserting a piv is not making the area sterile. You are not doing surgery. You're not even cleaning the area according to blood culture standards. So when you stick the patient twice, there is a higher bacterial load in the catheter that can go to the bloodstream or surrounding tissues.

[broughden]

Because the wipe you do when inserting a piv is not making the area sterile. You are not doing surgery. You're not even cleaning the area according to blood culture standards. So when you stick the patient twice, there is a higher bacterial load in the catheter that can go to the bloodstream or surrounding tissues.

If that's true then wouldn't you need a new needle for every single stitch you do when suturing a patient? Because with each stitch you are reinserting the needle again and again?

(And I'm not replying to be argumentative but to actually learn.)

[cleback]

If that's true then wouldn't you need a new needle for every single stitch you do when suturing a patient? Because with each stitch you are reinserting the needle again and again?

(And I'm not replying to be argumentative but to actually learn.)

I'd say a hollow bore needle, not a suture needle, carries more risk (as evidence by the risk of needlestick injuries are always higher with hollow bore needles, more blood and bio burden within the lumen). And that you're leaving the catheter within someone's large blood vessel.

But honestly, I too could come up with examples of needles being reused and still being standard practice. Joint injections for pain relief the needle is often reused. And it makes me cringe every time I see it and not at all surprised at the number of post procedural joint infections. Dental numbing is another where they just keep poking at you with the same needle.

I can't speak on why medicine has evolved that some risk is OK and others are not. But I do stand by the original statement that the skin disinfectant reduces microbe burden but does not make it sterile. To reuse the needle means you're taking whatever microbes from the first stick and putting it directly into your new site. It's a higher and an avoidable risk.

[broughden]

I'd say a hollow bore needle, not a suture needle, carries more risk (as evidence by the risk of needlestick injuries are always higher with hollow bore needles, more blood and bio burden within the lumen). And that you're leaving the catheter within someone's large blood vessel.

But honestly, I too could come up with examples of needles being reused and still being standard practice. Joint injections for pain relief the needle is often reused. And it makes me cringe every time I see it and not at all surprised at the number of post procedural joint infections. Dental numbing is another where they just keep poking at you with the same needle.

I can't speak on why medicine has evolved that some risk is OK and others are not. But I do stand by the original statement that the skin disinfectant reduces microbe burden but does not make it sterile. To reuse the needle means you're taking whatever microbes from the first stick and putting it directly into your new site. It's a higher and an avoidable risk.

Good points! I hadnt even thought of the mouth and anesthesia injections. And the mouth is one of the filthiest places on the human body.

I appreciate the discussion. And will definitely keep this in mind in the future.

We were totally ignoring this standard though back when I was in the army and we were doing IV training. We'd all stick each other multiple times, blowing veins and creating hematomas everywhere, all the with the same catheter/stylet. LOL

[AJJKRN]

What has changed that introduced more bacteria?

I would imagine the increase in risk that the catheter/needle picked up the already normal bacteria from the area of the first portal of entry and will introduce it into another portal of entry on the reinsertion area increasing the infection risk that way maybe? The needle should initially be sterile coming out of the package and is now a full blown fomite right? Only instead of carrying germs to another person it's just carrying germs to another area of the persons skin, albeit a short distance and to an area that was cleaned and prepped but not able to be sterilized. Just more germ bang for your buck aye!

I dunno, I do know I need coffee though!

[IVRUS, BSN, RN]

Sticking twice with a needle on the same (properly cleaned site) is not 100% correct, but it isn't outrageously risky or negligent either.

The biggest infection risk for peripheral IVs IMO is when the dressing becomes compromised.

For example, if you have a somewhat hairy armed man and place an IV without shaving a small area first, you can guarantee that the seal around your tegaderm won't last six hours.

First of all, please remember that reusing an IV catheter after an unsuccessful attempt to insert it, is NEGLIGENT. Negligence is the opposite of diligence, or being careful according to most dictionaries. You are NOT careful if you are resheathing a needle that has been placed, or was attempting to be placed and the skin has been punctured. Nor or you being careful if you remove the needle and the catheter as a whole and then re-puncture the skin to get into the vein with the same IV catheter. Since skin can never be rendered sterile, what are you dragging into the body with the second Venipuncture of that IV catheter? Please just say NO!

[LibraNurse27, BSN, RN]

I was relieved to see the patient continued to improve and was just discharged to SNF but still not going to let this happen again... so much anxiety and perseveration and imagining the worst case scenario. I never used to suffer from anxiety but since becoming a nurse I'm nearly always anxious. Maybe my next thread will be asking for tips on decreasing anxiety! Thanks again for all the replies; interesting discussion.

[IVRUS, BSN, RN]

I was relieved to see the patient continued to improve and was just discharged to SNF but still not going to let this happen again... so much anxiety and perseveration and imagining the worst case scenario. I never used to suffer from anxiety but since becoming a nurse I'm nearly always anxious. Maybe my next thread will be asking for tips on decreasing anxiety! Thanks again for all the replies; interesting discussion.

Ah Libra, Anxiety happens... I've been a nurse over 30 years, and still have times when anxiety over a patient issue is prevalent. What will diminish the anxiety is knowing the right way, and never deviating from sound, clinical practice and when in doubt, Stop, and stay on the safe, cautious side of patient care. You are a nurse, you got to this place by testing out, and knowing how to practice nursing. Is education a continuous practice..you bet, and one never stops learning. Blessings to you!

[LibraNurse27, BSN, RN]

Thank you for your kind words IVRUS. I totally agree the best way to prevent anxiety is by taking the time and effort to do things the way you know is 100% correct!

[HiddencatBSN, BSN]

Once it's out of the skin I start over with a new needle. I think there maybe has been a situation where I just went for it but it's not my standard practice to do so.