One of the things I appreciate about you, my readers, is that you are comfortable pointing out when I screwed up.
Blogs become extensions of their author's personality. I would rather have somebody publicly point out that I am human and subject to frailty and error than to leave an error unchallenged.
Today it was Belladonna who straightened me out. And I am glad she did.
She was referring to my account of her getting stuck with a used needle.
Not a robust process
According to Bruce Kelly, a robust process is a process that will still produce acceptable outcomes in spite of anticipatable variation of the inputs.
Using a funnel while changing your oil is an example of a robust process. Any reasonable person will expect the jugs of motor oil to "glug" while pouring them. Furthermore, they are likely to have a large stand-off distance when you first start pouring. Those are sources of variation that can be anticipated.
A funnel has a large opening in the top and a small opening in the bottom. They really are a "funny-hole". The large hole in the top provides an enhanced target while the taper and small hole in the bottom reduces the dispersal to an acceptable level.
Belladonna busted my chops for suggesting that "...lack of mindfulness..." contributed to the problem. Three (entirely anticipatable) factors came into play:
- The child lashed out in an unexpected way even though three adults were attempting to restrain her (two of the adults were her parents). For the record, this could have just as easily been an adult who convulsed or had a seizure. While it is not possible to anticipate exactly WHICH patient will convulse, it is possible to ascertain that the number is significantly more than zero.
- The "space" was tight and constrained. There was no opportunity to use space to her advantage.
- The final factor was that her employer requires that all used needles be sheathed after use and before disposal. The sheathing system they mandate requires that the technician hold the sheath in one hand and spear it with the needle which is held in the other.
Belladonna implied that she had worked in other environments where the sheathing system was more robust. The picture in my head was that the sheath clam-shelled around the syringe-body and needle without having to point the needle at the hand holding the sheath. Of course, I may have this mental image cross-threaded in my head.
I know I have a few readers who are in the health professions. In your professional opinion, what is the most robust system for capturing used syringes/needles/caths with respect to reducing the risk of accidental "sticks"? Links to images will be appreciated. For the record, the needle in question was a "butterfly needle".
Been in the sick people business since 1975.
ReplyDeleteBeen a medic, RN (ER, ICU), nursing supervisor, and mid-level.
To say in 2022,that any sort of recapping is "ok", is so, so, so 1980's!!
Their engineering controls need more thought.
Needle boxes, either at bedside, it moved to bedside for every single needle/sharps involved procedure b
ReplyDeleteI, myself, will not accept employment at any agency that does otherwise.
Thank-you NP McFee
DeleteI've had needles used on me that have a sheath which slides up to expose the needle and then back down to cover it again - and then it still goes in the needle box.
ReplyDeleteI agree - any place that requires traditional recapping is asking for problems, and I bet their insurance doesn't know they are doing it that way!
I don't use a funnel, that spilled stuff is good for the grass!
ReplyDeleteIf a butterfly needle is the item I'm thinking of (https://www.healthline.com/health/butterfly-needle), there may be no good engineering solution for the sheathing part. Moving to a different type of needle might be called for, it it would work.
ReplyDeleteI have great confidence in the system that invented zip-ties and duct tape.
DeleteMy experience (large Australian Research Institute, lab research and membership of said instutute's safety committee) is that recapping needles is:
ReplyDelete- Heavily discouraged.
- The most common cause of needle-stick injuries.
The usual 'replacement' procedure is to put the needle directly into an approved sharps container as soon as it has been used. The use of a blunt needle - not one which has been blunted, a needle that has been manufactured blunt - is recommended where possible - obviously not possible in Belladonna's case.
D.
I'm not a medical professional, but I have long been under the impression that re-capping needles was unacceptable. As a farmer working with livestock, yes I have re-capped and re-used needles. And yes, I have been stuck. Fortunately without any bad results other than a sore finger,
ReplyDeleteRecapping used needles, especially by holding the cap in your off hand, is foolish. As DJB Hunter says, have a readily-available sharps box if you're (institutionally) paranoid about needles. Any place that mandates hand-capping of used needles is run by fools.
ReplyDeleteThose "self-capping" needles are IMNSHO a BAD idea. Our hospital went to those, briefly, years ago. To make the self-capping possible, the needles had to be made much longer. For small-bore needles (e.g. 26-gauge) they actually were bendy, and made it difficult to properly place your stick. Not what you want when doing, say, an ABG. Personally after about two days of trying to use the damned things I sneaked into a rarely-used (and therefore stocked but not updated) store room and "liberated" all the old stock regular needles I could find, creating my private stash.
We had more needle-stick injuries with the unwieldy "safe" auto-capping needles than with regular needles and a bit of care. That was an initiative that lasted about 6 months. (I think what really got admin's attention was the simultaneous introduction of "safe" kits for thoracentesis. Turned out the "safe" chest needles had no haptic feedback, and dropped lungs (accidental puncture of the actual airsac) went up over fivefold. This was hurting patients, not only staff (as with the flexy "safe" needles) so attention was paid and all that "safe" stuff went away in under a year.
A Sharps Container.
ReplyDeleteRecapping is definitely risky. Sharps containers with an appropriate lid are much better.
ReplyDeleteWhen I'm done with parvo shots, I just stab the need into the little jar cap and break it off. Easy peasy. Getting rid of an IV needle, probably isn't as easy. Maybe stab the bag? (not the mom, the iv bag.)
ReplyDelete