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Poked with dirty needle...

36 posts in this topic

Posted · Report post

So, yesterday, a medic who rode with us to the hospital while transporting an 87yro female from nursing home, SOB with wheezes.

Incident:

He attempted an IV, 22 gauge, blew the vein, pulled out, blood started flowing out, he asked for a 4x4, I turned to the counter, opened one, folded it, turned back and put my hand toward the bleeding hand which he was holding, and the anterior part of my pointer finger hit the needle he was still holding in his hand. Went in deep (for a finger).

Comments:

Stupid accident. The needles retract automatically when you press the button (we were pulling up to hospital, so he wasn't going to try again) and he had enough time. He was really fast paced, so I was trying to keep and should have done things slower. TWICE earlier that day, I had remarked to my partner and a trainee about how going slow and steady causes fewer mistakes, but I let someone else influence my style. My mistake.

Patient/Clinic Info:

ANYWAY, 87yro white female, hx dementia (so she can't consent to blood test), urosepsis. My company's workers comp clinic gave me a prescription for "Combivir (300mg Zidovudine / 150mg lamivudine) #62 T PO BIN x 31 days" as a precaution.

My Concerns/Questions:

Apparently, it's the HIV cocktail, makes you throw up, beats the hell out of your liver, so I'd have to go in for followups to check liver output. Needs to be starting within 72 hours (this happened last night). No alcohol for a month (so much for this birthday weekend in Vegas).

Has this happened to anyone else? Did you choose to take the cocktail? What did it do to you? Discussed incident with ER doctor at receiving hospital. He said with the patient's hx, he wouldn't recommend any meds. We were looking off the nursing home papers they sent. No IV abuse hx seen. HIV emerged in 80s in US, right? I kind of doubt she was promiscuously-sexually active at age of 60?

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Posted · Report post

Yes sounds low risk. I haven't had any needle sticks but I have had multiple exposures to the usual suspects.

I am not sure but people I have come in contact with that have had needle sticks, don't usually take the meds unless it medium to high risk. That however is a decision you have to make. Couldn't they contact a family member of the patient for consent on testing her? It sounds very low risk, but if you need to know for piece of mind, thats fine too.

The needles are als providers use now are the protective caths, when they withdraw them the needle locks inside. We also use the protective lancets.

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Posted · Report post

First thing first

you should write out an incident report and talk to you supervisor. You work in a system that I believe has some sort of infection control person right?

The infection control nurse at the receiving hospital should be someone you contact to but go through channels to get it done.

Sounds low risk but even people who don't look like they have a communicable disease may have one.

STart the ball rolling buddy just in case if you ask me.

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Posted · Report post

Oh and one other thing, the behaviour of your medic ridea long should be reported too. He sounds like he's gonna get someone else hurt. Why didn't he retract the needle when he should have.

address this with him or your supervisor and make sure he doesn't screw anyone again.

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Posted · Report post

Got ball rolling last night. Did incident and exposure report forms and had blood drawn our company's clinic. Today, I got a callback from the hospital's infection control. Patient's doctor agreed to a blood draw.

I called the nursing home again and spoke to an administrator who gave me a more thorough patient report than the one last night.

The in-house doctor's diagnosis (May 12, 2007) when she first came to the nursing home:

-Poliomicrobic cystitis

-Bacteremia

-Advanced DAT (I have to find out what this means)

-Stage 4 Pressure sores on sacral area

-Type II Diabetes, HTN, Chronic Anemia, Dementia with Alzheimers

Her blood test will take 3 - 4 days to come back...after the point which I'm supposed to start the HIV/AIDS precautionary cocktail.

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Posted · Report post

Anthony wrote:

Advanced DAT (I have to find out what this means)

Its advanced dementia of the an Alzheimer's patient.

Good luck

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Posted · Report post

Anthony,

I don't think you have to take the " HIV cocktail " if her blood test comes back negative for the virus. It is my understanding that one only need start treatment when there is a positive test result. If I'm wrong, I know I'll be corrected. :wink:

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Posted · Report post

He may have to have the cocktail if it was a very high risk patient but this one sounds like they are low risk.

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Posted · Report post

In this exposure, it's risk vs. benefit. This is exactly why rapid HIV tests were invented. You can find out within an hour if the pt. is HIV+, then take the cocktail if indicated. The drugs are not "risk free", and yeah, they'll make you feel like crap. That should not discourage anyone from taking them when indicated. Taking them for one month sucks, taking them for a lifetime sucks more.

I'm not going to say whether or not you should take them. Another doc- YOUR doc- says you should. You can always stop taking them once the test comes back.

I agree with what Ruff said. Your company should (hopefully) have a policy where you can check into the ER at the receiving facility and testing of the patient can be done. Next time, do that. There is a house officer there 24/7 that knows how to handle this sort of thing immediately.

Here in Ohio, a patient cannot refuse testing after an exposure of a healthcare worker to the pt's blood.

'zilla

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Posted · Report post

I don't think you have to take the " HIV cocktail " if her blood test comes back negative for the virus. It is my understanding that one only need start treatment when there is a positive test result. If I'm wrong, I know I'll be corrected. :wink:

Just to correct you here, :D the antiviral cocktail must be started ASAP after an exposure. Within an hour or two is best. If the rapid (1 hour) HIV test isn't available, then it usually takes 4-7 days for the HIV test to be completed, and it would behove the exposed employee to take the cocktail until the test comes back.

'zilla

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