Monday, November 30, 2009

Needle Sticks and Scapel Injuries

I've been stuck by a sharp object twice in my medical career. The first time, I was doing a lumbar puncture, aka spinal tap, on a 3 week old neonate for a complete septic workup. I had everything prepped and had the long spinal needle in my right thumb and middle finger. As I was turning to ask the assistant something, I poked myself at the tip of the index finger. Fortunately, the needle was clean and I had not even began the procedure. I washed up immediately and was not concerned about infection or tetany (I had my tetanus shot 2 years ago)

Recently, I was about to place a chest tube on a patient.
I prepped the skin and injected generous amounts of lidocaine into the tissue. I made a small incision with my scalpel above T4 level along the anterior axillary line and placed the bloody scapel on the sterile drape over the mayo stand.

I turned to grab the Kelly's and instead stabbed myself with the scalpel on my right thumb through the latex glove. Blood oozed immediately into the glove and yet I felt no pain.

My attending told me, "Sam, wash your hands like you've never washed them before." Luckily, the surgical residents were right next to me and took over the procedure. We didn't know too much about this patient, so it was frightening to consider that I could become infected with HIV, Hep B, Hep C, or other bugs.

Although, I've taken care of several staff with needle exposures, I'd never personally really felt the fear of the unknown. A rapid HIV test was ordered on the patient, along with Hep B and Hep C testing. The wait felt like it took forever and I was offered a triple combination of HIV antiviral medications. Should I take them? I pondered as I looked over the CDC recommendations:

As you can see above, I am in the "Source HIV status unknown" and "More severe injury type." CDC does not generally recommend taking PEP. However, I opted to take one dose now, as its most effective in the first 1-2hrs, plus I got some Zofran ODT to prevent nausea/vomiting.

Overall, everything turned out OK for me (pending studies). I gained several insights about needle sticks during this encounter:

1) Although the risk is very low, it's mind-boggling freaky to be faced with the diseases that can change your life.

2) During procedures and traumas, it's particularly important to SLOW down and be aware of each and every sharp object on the table.

3) Percutaneous injuries are very common in the hospital. Even with all the safety mechanisms, more automatic methods need to be created to prevent them.

For example, in the central line kits, there is Styrofoam piece designed to temporarily place needles into.

My suggestion: Please place one in the chest tube kit!


Minh said...

Thank you for your abundant knowledge and tips. I love looking at your blog during class, thanks for the graphics. Keep up the good work & be safe!
- Minh & Katherine K.
(your fan club)

Rae said...

hi sam, found this thru your FB profile. I'll enjoy reading about your adventures from time to time (hopefully no more sticks!)

I've never got stuck, but did have my eyes splashed with fluid. It's pretty overwhelming when it first happens!

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