Friday, June 16, 2006

Pokes

I stuck myself with a needle from a patient the other day. Rats. I was suturing an umbilical catheter into place - think of it as a big IV in the belly button - and accidentally poked the suture needle into my finger. What a pain - not because it hurt much, but because it meant I had to go to employee health and fill out a million forms, get hepatitis and HIV labs drawn, and wonder whether the mother of the baby had any of those diseases. Unfortunately, she had no prenatal care so we didn't immediately know her status regarding them. I went to her room and asked her about things like IV drug use and hepatitis. She was very nice and denied any of those things. More importantly, her labs came back negative for hepatitis and HIV.

It reminded me of a pediatrician friend of mine who poked herself with a needle from an AIDS patient in the mid 1980's. This was near the beginning of the whole AIDS thing, and we didn't yet have real good information on the risk of transmission of HIV by a needle stick. My pediatrician friend was breastfeeding her 8 month old baby at the time and had a decision to make. Should she stop breastfeeding because if she did contract HIV from the needle stick she could potentially pass it on to her baby through breast milk? Or should she keep breastfeeding, knowing its advantages and thinking, to the best of our preliminary knowledge then, that her risk of actually developing HIV infection was small?

Now that question would be easier to answer, because we know that the risk of acquiring HIV from a needle stick is small - my employee health friends tell me it's one to three out of a thousand - and because if we are worried about the risk we can take effective anti-HIV drugs until we're sure the person poked doesn't get HIV. But we didn't know those numbers back then and we didn't have good anti-HIV drugs.

My friend kept breastfeeding. I guess it was the right decision, because she and her daughter - now a college student - remain in excellent health. It's not the real risk of infection from needle pokes that bother health care workers; it's just the natural worry.

5 Comments:

Blogger stockingup99 said...

HIV causes scary things to happen. My ex-church told me that breastmilk is a hazardous bodily fluid, and asked me to dump out my precious bottle, and refill it with formula. I took my baby and left in tears.

Even after sending OSHA and CDC statements to them which state that it is not, they still offer their free 'safer' formula to new mom who exclusively breastfeed.

Saying a little prayer for you, Neonatal Doc. Good Health.

2:56 PM  
Anonymous Anonymous said...

About back in the 80s and HIV and AIDS. I'm still angry when I think about this. I was working as a private home health AIDE at the time. I was sent to take care of a man for 4 hrs. each day who I was told was a "Cancer" victim. I was young and not experienced at registered nursing care. I was only educated to be an aide at that time.

The nurse came the first day and taught me how to flush this guys IVS, when to start them, what medications to give him, how to take care of his cath. etc, etc....Keep in mind I was inexperienced and being told to work with all these needles that I had no training to do.

After 3 months I found out that the guy was not dying from cancer he was dying from AIDS. This came out when I had taken him to his Dr. visit and the Dr. himself talked about it...Shit, shit, shit! My DAD threw the biggest fit you could ever imagine..Why did they keep this info from his daughter? Why wasn't a nurse going everyday to take care of this IV and inject his medications? DID they know he was going to sue their asses off for putting his daughter at risk in this way?

Well, he didn't sue anyone and I had tests done many times over the next few years. I must have handled all those needles and body fluids just fine, because I never got HIV or AIDS. But what a shitty thing to do to someone. That home nursing company was soon closed down for unknown reasons. It almost made me change my mind about wanting a career in medicine.

6:48 PM  
Blogger Flea said...

There's a palpable difference in attitude toward sticks today and in the 80's. I'm glad that era is over.

best,

Flea

7:57 PM  
Blogger NeoNurseChic said...

This comment has been removed by a blog administrator.

1:35 AM  
Blogger NeoNurseChic said...

ND, I'm so sorry that happened to you, but glad the mom was very receptive. It is my hope that people would react that way, but here is my needle-stick story... (Sorry if I've shared this before...I can't remember!)

Over a year ago, I was doing a nursing clinical rotation through an urban "free" clinic. The clinic did not have safety lancets for glucose testing. They had the white twisty lancets that go in the pen, but they didn't use the pen since that would cross-contaminate, so we just twisted the top off the lancet, held the person's finger, and poked. The guy was irritable as it was, and the glucose monitor errored after I stuck him, so I was going to have to re-run the test. The needle box was across the room, and you had to actually open it to put things inside. The guy's anger at needing to re-test kind of threw me since I was in the room alone with him, and I picked up the materials on my desk in haste.

The lancet went through my glove and into my thumb. It was like the scene in "Outbreak" (one of my fav movies) where the blood starts spreading under the glove as your stomach literally sinks. My immediate reaction was, "OMG! What did I do?! I can't tell anyone!! I'll get in trouble and I can't believe I was that careless!!!" The supervising nurse I was working with came into the room because she heard the commotion of the guy's anger about the test needing to be re-run, and I quickly told her what had happened. I was already at the sink scrubbing my hand. She actually did chastise me for being careless, and I immediately was in tears. Later, she was more kind about it - which helped....

So the patient went in to see his doctor, and the doctor asked him about getting a repeat HIV test. I won't get into his history, but I can say that he had tested negative, but it was several years prior. However, there were things that had me quite concerned that I won't get into here for reasons of confidentiality.

Then the kicker. In PA, there is no law that requires someone to test for HIV and Hepatitis mandatorily after a needlestick if someone has been stuck with your blood. The guy, already angry at me for the glucose testing, refused to re-test. He told the doctor that it was my fault for getting stuck, so why should he have to go through the testing again? He's right in that it was my fault, but still.......common courtesy? Decency? I wondered that if he refused to re-test, was he refusing because he was concerned about what the test might show? I'll never know the answers to those questions....

I called my clinical supervisor who was not on site. It was only my second day in the clinic, and my fellow student was on her day hospice rotation, so I was alone! My clinical instructor had me fill out an incident report, collect all necessary information, and go back to the university health for testing and counseling. The clinic staff said they could do everything there for me, but I wanted to be out of there.

Back at the university, they ran all the initial tests, gave me counseling, and we discussed further treatment. Ultimately because of the nature of the situation, I decided to go ahead and take the Combivir for a month. I was warned about the side effects, but I never felt any. I was already so fatigued that the combivir really did nothing more to me. At least that was a relief. I knew that my HIV risk was slim to none, especially since I'd been stuck by a lancet, which does not hold blood - as opposed to a needle that would hold blood inside. I was significantly more concerned about Hep C.

After that experience, I was actually really ashamed that I had been so careless and gotten stuck. I was embarrassed. I did, however, find out that a very similar situation had happened to another student in my class at the SAME clinic, but he had made the decision not to take any action at all - which was a big risk as he was married and had children! I would have at least wanted it reported and gotten basic testing, even if I didn't take treatment... It was amazing how many people shared their needlestick stories after I would discuss mine...

Ultimately it turned out fine - I knew I was okay, but it was more the worry and fear that had me distressed. The worst was that the guy refused to retest or even acknowledge that he could alleviate my stress and worry by doing so. If it were me in his position, even though I know with 100% certainty that I was negative for everything, I would have re-tested just to put the health care worker's mind at ease....and this is the decision I would have always made, even before this happened to me...

Sorry this is such a long response - just felt the need to share my story! It helps to be able to talk about it with those who have "been there..." even though I wouldn't wish that on anyone!


And to anonymous - I'm so sorry about your experience as a home health aide. That is really horrifying, and I feel so badly that you had to go through that!! I, too, remember how different attitudes used to be. I was born in 1980, and when I was in 2nd grade, my brother was in kindergarten. He had gotten hives from an allergy, and there was this kid (known bully) on our bus who looked at my brother's hives and yelled that my brother had AIDS. I have no idea how I knew much about AIDS at my age then, but I stood up for my little brother and screamed back that he didn't have AIDS, he had hives... I vividly remember that experience even after all this time... I'm so glad that you did not become infeceted. I can't believe how immoral it was for the agency not to disclose to you that the man had AIDS as you were a direct care provider and were exposed to blood and bodily fluids. Your dad would have had every right to sue the agency in my mind! That is absolutely criminal!

Take care all,
Carrie :)

1:42 AM  

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