Needlesticks?

[Medic_QT]

This is a hot topic for my department cuz I'm awesome and got stuck recently.


Have you ever been stuck? How many times?
How long have you been a EMT-I/EMT-P? Are you a Basic who got stuck by a discarded sharp?
Were there any safety mechanisms?
Do you think it's just "one of the hazards" and bound to happen somewhere, sometime?


As for me, I've been stuck twice. I will have been a medic 2 years in July.

One time was when I was working an arrest (out of the prison--guy had prison tattoos and stuff...) and I was doing CPR. We'd just switched out, so I hadn't sat down yet. The guy up front stomped on the brakes and I went flying. My partner had started the IV in the truck (couldn't get one inside) and sharps, meet butt. Yes, my first sharps exposure was in my butt. There were no safety mechanisms. Just a straight needle with a flash chamber--No needle retractor or anything (I worked private EMS, so profits are #1). I mean, it's my fault, I wasn't sitting down, wasn't belted, but let's be serious, how often while working an arrest are you belted? They tested him for HIV/HepB/HepC, and it was all negative. I still have the scar though.


The other time was a couple of weeks ago on a 22yo overdose by pills. She reportedly took a bottle of vicodin, nighttime sinus pills, and antidepressants. She was acting lethargic but was still oriented. She was watching me start her line, and I used my script I use with everyone, "Ok, big poke on 3, don't move, 1, 2, 3." She had, ahem, extra insulation, so I had to feel deep for her vein, then moved my finger back up above it, advanced the needle deeper and she jerked her arm away right as I got flash. When she jerked her arm, the needle came out and jabbed my finger. There was blood inside and outside of the glove to the point where I couldn't tell whose was whose. It was just bad. They did rapid HIV/HepB/HepC on her and everything was negative.

It really upset me because she wasn't as lethargic as she pretended. She perked right up after the needlestick when the other medic asked what internship she was doing. She talked normally until the other medic held up a box of nighttime sinus pills and asked if she took them. Magically, she was lethargic again. It really really upset me because it'd be one thing if I hadn't moved my finger, but I moved my finger about 1 1/2 inches above the site, so I DIDN'T get stuck.

I think it's just one of the hazards that's bound to happen bouncing around in the back of a truck going down the road. I was being careful, but it still happened.


Thoughts?

[ltfd596]

I have been in EMS for 12 years and I have been stuck twice.

Years ago when I was working the privates while attending college I got stuck in the a$$ because I sat on my own needle. I started a line on a code, and couldn't reach the sharps container so I sat it down on the bench seat. I forgot I put it there and slid down to check something and I jab myself. I know stupid, but I have done worse. I got all the testing and came out OK.

The second time I got stuck was while pushing adenosie on a SVT patient. I was backing up a private ambulance. They had the line already started, but their line set only have the "needle" port. I placing the med and the flush in the same line and I wasn't paying attention and I jabbed my thumb with the needle that had the flush. It was sterile and it was only NS, but I still had to document it. But this time no BBP testing.

[pdxmedic]

I stabbed myself in the finger with an amio-soaked needle during some realistic scenarios in my last ACLS recert, does that count? ;)

[Medic_QT]

I stabbed myself in the finger with an amio-soaked needle during some realistic scenarios in my last ACLS recert, does that count? ;)


Only cuz it's you, and you're special. Along those lines, we had two needlesticks in my basic class.. One was a live epi pen that was in with the trainers. It was supposed to be an example, but I guess someone in the other class put it in with the trainers. Another was a vacutainer. Someone was playing with the rubber part of the needle that punctures the tube, not realizing there was a big ass needle in it.


Years ago when I was working the privates while attending college I got stuck in the a$$...

I'm glad I'm not the only one that took a sharps to the butt.

[pdxmedic]

Oh, the epi-pens. I went on a bee sting once, and enroute we got an update that we now had two patients, no further info. We're going, "hmm, swarm of bees maybe?"

Nope. Get there, and here's the stung pt having a moderate reaction. On the table is an epi-pen with the needle bent at a 45-degree angle, and the neighbor holding his thumb. "Dammit, when will my heart stop racing, guys?"

Oh, it was funny...

[JenVTemt]

I'm surprised so many people have gotten stuck in the butt!

I've only been stuck by a clean needle. It happened just as I uncapped it to start an IV. We went over a bump (frost heave) and the 18ga needle went right into my thumb. Ouch.

Since Ive been in EMS I've known of 2 instances where people were stuck. Once was on a code while one person passed a used needle to another to put in a sharps container. The room was poorly lit, small, and had about 8 people in it causing a lot of confusion. To confound the problem the patient was Hep C positive, but the person stuck was tested per protocol and found to be neg.

The other instances was a Basic who was handed a pile of trash to put in a bio-bag as they were cleaning a rig after an arrest. The person handing the trash advised there were no sharps in it. As the basic grabbed it he was stuck by a needle hidden in the trash. It was just a draw needle used to get epi out of the vial, never used on the patient.

[MedicMike]

I guess I'm lucky in that both places I've worked have the 'safety' caths where the needle retracts back into the plastic hub, making it almost impossible to get stuck that way.
Of course there are still other times when dirty needles are exposed, like after you give a med IM/SQ.

I did almost stab myself while trying to give a med in a needle port on an IV line once, but all my EMS accidents involve being thrown around the back and being knocked unconscious.

[fishy]

Once, in over 9 years now, and it was way back then when I had my clinicals for Basic in the ER in 1999. Stabbed myself in the thumb after drawing bllod from a patient, stupid mistake and all my fault, but hey I was an FNG at the time. What scared the crap outta me was when the nurse told me the pt was hep C positive. Luckly all my test results came back negative.

As of 2 years back all needles are equiped with safety thingies. They retract into a metal thingie that covers the needle point. They are required by law nowadays.

[Medic_QT]

As of 2 years back all needles are equiped with safety thingies. They retract into a metal thingie that covers the needle point. They are required by law nowadays.

False.

Needles in our airway kits for my 911 service aren't safety needles, neither are some of the large bore IV caths in my ER. Nothing at my private service has a safety device. Medics around here still have needled ports. At least in the ER everything that can be, is needleless. BD still makes non-safety needles. I did inventory for my private service a couple of times, and put away supplies all the time there. Not to mention, I got stabbed in the ass by one last year.

http://www.buyemp.com/product/1120103.html

That's the needle that I was stabbed with in my first exposure. Angiocath, needle and flash chamber. No retractor.

[jdemaio]

I must say that my needle stick was very undramatic. I was in the back of the bus, during an arrest, about to draw up a drug. We hit a bump. The needle went parallel to the vial and into my palm.

[JenVTemt]

Most needles do have retractors now, but the thing is you have to retract the needle in order for them to protect you. Prior to needle use, during use, and shortly after, the needle is exposed... until you have the opportunity to retract it.

[scribble]

False.

Needles in our airway kits for my 911 service aren't safety needles, neither are some of the large bore IV caths in my ER. Nothing at my private service has a safety device. Medics around here still have needled ports. At least in the ER everything that can be, is needleless. BD still makes non-safety needles. I did inventory for my private service a couple of times, and put away supplies all the time there. Not to mention, I got stabbed in the ass by one last year.

http://www.buyemp.com/product/1120103.html

That's the needle that I was stabbed with in my first exposure. Angiocath, needle and flash chamber. No retractor.
Fishy's german. they do things different over there.

I've never been stuck, but I have found sharps left behind by ALS crews the day before, etc.

A cautionary tale:

When I was a kid our nextdoor neighbor was a nurse and kindof a ditz. Nice lady, just lacked common sense. She got several needlesticks over the course of a few years AND NEVER DOCUMENTED THEM. Then she started getting sick. All kinds of weird symptoms. Hep C was the LEAST of her problems. She probably had six different sets of symptoms for six different illnesses. Because she'd never documented anything, they had no idea what she might have been exposed to and when. Eventually they got her more or less stabilized, but it was hell there for a few years.

[bubbamedic]

I've been in healthcare in some form for 20 years now. The funny thing is I was stuck in the field only once, but in the ER or the hospital...

The field stick was when a volunteer (bless their souls, but this one has no business in the field) decided to pick up a catheter and uncap it and handed it to me from behind while starting a line on a combative patient. The guy managed to stick the thing into my palm as I held my hand out steady. Sterile needle, unless he licked it to help it glide in to, so I wrote it up and not much came from it. The guy stayed away from medical calls since.

The hospital is a different story...

First one was while cleaning up an ICU room after a patient was discharged. The nurse was taking the linens off of a bed and throwing them on the floor. I was bundling the linens off the floor when a needle stuck into my palm. No one could figure out if the 18 gauge needle (without a syringe) was used, used for what, or what it was doing in the bed in the first place. This was at the time the hospital was going needle-less and not everything was needle-less, namely the drugs. My theory was someone drew something up and had to remove the needle to administer it in the needle-less port. How the patient did not get stuck is a mystery. Still did the testing and such.

Second, stuck by a nurse in an ER. Not the brightest nurse in the first place, but she decided that medical floor nursing was not cut out for her so transferred to the ER. While working a COR, I was pumping the chest and she just gave the patient something (think it was Epi) and managed to stab me in the tricep as she turned to put it in the sharps. She claimed I backed into her, which changed to I did not remain still as she called out "Sharps", thus it was my fault. Doc reamed her so bad that I did not have the heart to say anything. She mysteriously disappeared after two other shifts. Had to do the testing for this too. Risk Management was getting to know me too well.

The others were for fluid exposures, not sticks.

[mike]

I was going to give a patient morphine in the back of the bus and we hit a bump and popped myself in the thumb. That blew, not a dirty needle but the paperwork sucked.

As far as dirty sticks ALWAYS report it, YOU own it if you don’t.

[shfd739fm]

Ive had a few with clean needles but none with dirtys. I try really hard to be careful with the dirtys and every thing at my service is needleless save for the narcan and glucagon injection. Everything else comes needleless or is drawn up with needle but given needleless so there are few dirty needles going around.

[CHASgirl6204]

Most needles do have retractors now, but the thing is you have to retract the needle in order for them to protect you. Prior to needle use, during use, and shortly after, the needle is exposed... until you have the opportunity to retract it.

Okay, IMO, the "shortly after" really shouldn't be an issue...UNLESS you have a patient freak and thrash around. When using the retractables: after getting your flash, advancing, etc, you should never EVER pull your needle out to the point where it is fully exposed. Occlude your vein, pull back, and retract. Easy peasy.

But prepping for your IV, drawing up your meds and getting ready to administer them is a completely different story.

[JenVTemt]

Okay, IMO, the "shortly after" really shouldn't be an issue...UNLESS you have a patient freak and thrash around. When using the retractables: after getting your flash, advancing, etc, you should never EVER pull your needle out to the point where it is fully exposed. Occlude your vein, pull back, and retract. Easy peasy.

But prepping for your IV, drawing up your meds and getting ready to administer them is a completely different story.

I wasn't necessarily referring to starting IVs. Personally, with the IV catheters we use you HAVE to retract the needle safely to advance the catheter into the vein. But there are times, like when administering drugs IM/SQ when you may have an exposed needle for a few seconds. You also have to REMEMBER to flip the little cover to cap the needle. I've never not capped one (to my knowledge), but it DOES happen or an accidental stick may happen before you get a chance to cap it.

[fishy]

Fishy's german. they do things different over there.


As mentioned elsewhere, I'm different :)
But she has a point. I didn't think of airway kits or the needles in our central line kits (the ones through which you push the guidewire). Those aren't "safety"-needles. I think the rule over here only applies to IV-caths and "butterflys".

[Medic_QT]

As mentioned elsewhere, I'm different :)
But she has a point. I didn't think of airway kits or the needles in our central line kits (the ones through which you push the guidewire). Those aren't "safety"-needles. I think the rule over here only applies to IV-caths and "butterflys".

That's a big oops on my part. For some reason I just automatically assume everyone is on my side of the pond.


Most needles do have retractors now, but the thing is you have to retract the needle in order for them to protect you. Prior to needle use, during use, and shortly after, the needle is exposed... until you have the opportunity to retract it.

That's what happened to me. My patient who had "overdosed" (I use the term loosely) flung her arm, the needle and catheter came out of her arm as I got flash, and jabbed my index finger. It's all well and good to have safety devices, and I love them, but it doesn't help when your patient is just stupid.

[just_jessEMS]

Knock on plastic i have never been stuck... i have been doing this for 3 years

[jozak78]

i've only every been stuck with clean needles

[Philly Medic]

False.

Needles in our airway kits for my 911 service aren't safety needles, neither are some of the large bore IV caths in my ER. Nothing at my private service has a safety device. Medics around here still have needled ports. At least in the ER everything that can be, is needleless. BD still makes non-safety needles. I did inventory for my private service a couple of times, and put away supplies all the time there. Not to mention, I got stabbed in the ass by one last year.

http://www.buyemp.com/product/1120103.html

That's the needle that I was stabbed with in my first exposure. Angiocath, needle and flash chamber. No retractor.


Fishy is from Germany so it might be the law over there.

[fdnyemt5330]

I have been stuck once.

I was assisitng a medic unit on an OD who was not breathing. Thankfully, the medics started a line instead of using a saline lock. Anyhow, one of the medics pushed the narcan, and the patient was a dissatisfied customer.

He attacked all of us, and did so before the medic who was next to me had a chance to get rid of the needle. Needle, meet Patrick's face. I went to the ER, and they told me that because they used a line instead of a saline lock, it was far enough away from the patient that there was no chance of contact with his blood.

[mjaad03]

I think I was on the job about 8 months and got stuck. Not only was I sweatin' it cause I was a probie but the guy was a transient that had episodes where he just got on a bus and went somewhere. He didn't know why, where, or how he got where he was most of the time. And at that time they couldn't tell you if the other person had something, it just kept you guessing. That ****tail they give you sucks by the way!

[FlyDoc]

I never have been stuck, It just makes me wander why there are so many? worked for about 4 years in a busy service, then with all the combat flying and pilots yanking and banking with out announcing it. I just must be lucky!!

[anthonyt]

I've stuck myself with many clean needles, on accident. And a couple with not so clean needles. One time in particular, I was stuck with a dirty needle by a partner.

We were three deep, and while driving down the street, he was attempting an IV, and I was getting a BP on the other arm, the driver hit a huge bump, and the needle would up in my hand, after already being inserted into the patients vein.

That one was the worst. He felt so bad for months. I just kept telling him that it was ok, I'd be moving my family into his house soon, so that when I died, he could raise my kids. Thank GOD that the patient wasn't infected.

And this is the biggest reason why I don't do IV's while the truck is moving.

[Medic_QT]

That ****tail they give you sucks by the way!

The only treatments I've had so far is Latent Tb and Meningitis. The meningitis one SUCKED.


And this is the biggest reason why I don't do IV's while the truck is moving.

At my private service I do all of my IV's sitting still. If they're that sick, they're going to the nearest hospital, which is at the most 10 minutes away, less if you're going hot.

At my department job, we have anywhere from a 15-30 minute transport time, more if they request certain hospitals. From our closest station, we got a trauma into the trauma center in 22 minutes. If we're on the north side of the county, we usually fly them out. It could take 40 minutes to get them there running emergency status, while it takes the bird about 10 minutes to us.