Needle stick injuries

RE: Needle stick injuries

Rob Loxley — Wed, 19 Jul 2017 13:38:29 GMT

[quote user="Martin Atkinson"][quote user="robloxley"]If the dead space is likely to be significant, I'd suggest using zero dead space 1ml syringes, or insulin syringes[/quote]Do you not see the irony that insulin syringes have fixed needles so we've gone a full circle regards re-sheathing[/quote]

Of all the needles, I would always try to avoid re-sheathing insulin needles since they seem to have the softest plastic caps; the only times I've poked a needle through the cap have been with insulin needles. It's the same advice I give to clients injecting diabetic animals.

RE: Needle stick injuries

Martin Atkinson — Wed, 19 Jul 2017 12:26:49 GMT

[quote user="robloxley"]If the dead space is likely to be significant, I'd suggest using zero dead space 1ml syringes, or insulin syringes[/quote]Do you not see the irony that insulin syringes have fixed needles so we've gone a full circle regards re-sheathing and you might as well just stick (not sorry about the pun) with the original needle on a normal syringe!

Or as my nurse pointed out, as she is obviously far more intelligent than us: just draw the stuff out of the needle back into the syringe before you replace it. Doh!

RE: Needle stick injuries

Rob Loxley — Tue, 18 Jul 2017 18:52:13 GMT

[quote user="Noweia"]But by switching to a new needle you now have 0.05ml of deadspace in the hub, which reduces the amount given to the animal by 0.05ml?[/quote]

If the dead space is likely to be significant, I'd suggest using zero dead space 1ml syringes, or insulin syringes

RE: Needle stick injuries

Thomas Johnson — Sat, 15 Jul 2017 08:43:18 GMT

[quote user="Evelyn Barbour-Hill"]

Yes

[/quote]

Hooray! I got there eventually

RE: Needle stick injuries

Evelyn Barbour-Hill — Fri, 14 Jul 2017 18:49:33 GMT

Yes

RE: Needle stick injuries

Thomas Johnson — Fri, 14 Jul 2017 18:02:51 GMT

[quote user="Evelyn Barbour-Hill"]

Er, I think that's what we all said.

[/quote]

Perhaps I misread your post about not worrying about injecting a little air, I thought you meant that you just drew up the required amount and then just changed the needle, but thinking about it now did you mean that after you've drawn up the injection, you draw back a little further to empty the hub, change the needle and then inject without pushing the air out of the hub first? If so then that makes complete sense!

RE: Needle stick injuries

Evelyn Barbour-Hill — Fri, 14 Jul 2017 16:06:02 GMT

Er, I think that's what we all said.

RE: Needle stick injuries

Thomas Johnson — Fri, 14 Jul 2017 15:22:30 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Nicola M"]But if you pull back slightly on the plunger before you remove first needle, then put second needle on, then close down the space you've made then you don't lose any drug.[/quote]

Or, don't even bother to close down the space. It's a myth that a little bit of air in the injection is harmful.

[/quote]

I wouldn't be worried about injecting a small amount of air. However if, for example, I want to give an injection of 0.1ml, and I don't draw back further before changing the needle so discard the contents of the hub of the first needle, replace the needle and then inject the animal, as I depress the plunger I initially inject 0.05ml of air into the animal, while filling the hub with the syringe contents, as I continue to depress the plunger I inject 0.05ml of drug, leaving 0.05ml of the drug in the hub. I have only given the animal half the amount I intended.

RE: Needle stick injuries

Bob Russell — Thu, 13 Jul 2017 09:48:29 GMT

When I change needles the old one goes straight in the sharps container!

I don't have issues with re-capping needles carefully nor does the 0.05ml apparently lost matter most of the time. Very dose sensitive drugs are likely to be measured out in insulin type syringes anyway!

The EU regulations that appear to ban recapping also seems to be a statement of nonsense. Of course an uncapped needle is a hazard, it is very sharp!!

The risks associated with veterinary needle stick injuries are very minor, not much more than the needle at the end of a suture. Medical surgeons have far more to be worried about.

RE: Needle stick injuries

Martin Atkinson — Thu, 13 Jul 2017 09:44:50 GMT

[quote user="Iain Richards"]

Anyone up for the vetsurgeon.org sweepstake? Stakes will be placed on how many posts it takes a seemingly innocent enquiry to become a re-run of the Four Yorkshiremen sketch?

[/quote]I think we're already there. Godwin's Law next but even I'm struggling to see how we can invoke that.

[quote user="Iain Richards"]....except where the uncapped needle is itself a hazard.[/quote]That opens a huge grey area, including your bosoms and my brucellosis!

RE: Needle stick injuries

Iain Richards — Thu, 13 Jul 2017 09:32:26 GMT

A serious response. Europhobes will be delighted to hear about European Council Directive 2010/32/EU (the Sharps Directive), which does ban recapping of needles except where the uncapped needle is itself a hazard.

I'm slightly on the, "learn some co-ordination" school of thought, bearing in mind the content of said syringe/needle and the potential needle in the tendon sheath incident which might render my performance of Chopsticks untuneful.

RE: Needle stick injuries

Iain Richards — Thu, 13 Jul 2017 09:28:43 GMT

Anyone up for the vetsurgeon.org sweepstake? Stakes will be placed on how many posts it takes a seemingly innocent enquiry to become a re-run of the Four Yorkshiremen sketch?

RE: Needle stick injuries

Martin Atkinson — Thu, 13 Jul 2017 08:48:04 GMT

[quote user="Anthony Todd"]You guys don't know you're alive![/quote]When I was seeing practice in my second year the vet gave me an S19 syringe to hold, unsheathed, while he drove across a field and told me to be careful not to inject myself. Well guess what? As the bar bounced over the ruts I did just that and jabbed my hand. Far from suing the arse off him which is what would happen today I was too scared to tell him in case he told me off and a short while later I went down with what was at first thought to be glandular fever. This subsequently turned out to be brucellosis and resulted in me being bed ridden for a month with a couple of subsequent flare-ups and failing my second year. Fortunately I've not had any long-term repercussions.

I could never be certain that the needle incident was what caused it or if I caught from a cleansing or something else but I just wonder what 'elf and safety would say about that now?!

RE: Needle stick injuries

David Mills — Thu, 13 Jul 2017 00:19:42 GMT

Whatever happened to common sense and a bit of dexterity?

Yep, may happen. But you can never eliminate risk, just reduce it via expensive h and S companies whose existence is somewhat paradoxical.

RE: Needle stick injuries

Evelyn Barbour-Hill — Thu, 13 Jul 2017 00:04:51 GMT

Or, don't even bother to close down the space. It's a myth that a little bit of air in the injection is harmful.

RE: Needle stick injuries

Nicola Cole — Wed, 12 Jul 2017 23:10:58 GMT

[quote user="Noweia"]

But by switching to a new needle you now have 0.05ml of deadspace in the hub, which reduces the amount given to the animal by 0.05ml?

[/quote]

But if you pull back slightly on the plunger before you remove first needle, then put second needle on, then close down the space you've made then you don't lose any drug.

RE: Needle stick injuries

Noweia — Wed, 12 Jul 2017 23:02:04 GMT

But by switching to a new needle you now have 0.05ml of deadspace in the hub, which reduces the amount given to the animal by 0.05ml?

RE: Needle stick injuries

James Laidlaw — Wed, 12 Jul 2017 22:16:43 GMT

[quote user="Noweia"]

If you put a fresh needle on after drawing up the drug, then do you not need to take account of the 0.05 or so ml that will occupy the needle hub of the fresh needle, and not be transferred into the animal? No so much a problem in larger dogs but in smaller animals when maybe your total sedation volume is under 0.1ml it's a significant amount.

[/quote]

Usually the plunger stops above the hub and won't push the liquid out of the end of the syringe and needle if you have no air bubbles in the drawn up liquid though.

RE: Needle stick injuries

Noweia — Wed, 12 Jul 2017 22:11:45 GMT

RE: Needle stick injuries

Anthony Todd — Wed, 12 Jul 2017 18:41:35 GMT

You guys don't know you're alive!

Back in the day of Brucella abortus vaccination [leading to complete elimination in New Zealand!!! ] the live vaccine , Strain 19, was supplied in various sized glass bottles.

At the end of a day I had a few to do so I, plunged the multidose loading needle [about 10G] through the 25dose glass container into the ball of my hand....

A week of streptomycin intra gluteal [!!!] followed with apparently no illness, but a positive titre for blood donation, apparently for ever......

"Needle prick" pahhhh. that's what Kiwi vets call a "needle prick".....

RE: Needle stick injuries

Evelyn Barbour-Hill — Wed, 12 Jul 2017 17:26:17 GMT

[quote user="Bob Russell"] I do routinely change needles before injecting[/quote]

How do you handle the first needle when removing it? Isn't it a sight more sensible to put the sheath back on and then handle it by the sheath?

[quote user="Bob Russell"]Being tight fisted, I do get rid of syringes as pharmaceutical waste, not sharps,[/quote]

Yeah, my staff are trained, but I occasionally have to point out to locums that it's the sharps bin (the clue is in the name) and syringes are not sharp!

The point is, it's up to every principal to decide a needle-handling policy according to circumstances and risks in their particular practice. It's not for any outside body to come and dictate another policy because they say so.

RE: Needle stick injuries

bob lehner — Wed, 12 Jul 2017 17:13:42 GMT

[quote user="Clive Ansell"]I remember a colleague who pricked herself with a needle where the attached syringe contained dom/torb/ket, although the contents were not discharged. Being pregnant she was duly worried and trundled off to A&E. The consultant anaesthetist was not worried and said even if she injected the whole amount, it would probably would not have made any difference. She was fine.[/quote]

Seems a slightly gung-ho thing for the consultant to say.

This from the Domitor SPC:

'ii. Special precautions to be taken by the person administering the veterinary medicinal product to animals.

In the case of accidental oral intake or self-injection, seek medical advice immediately and show the package leaflet to the doctor but DO NOT DRIVE as sedation and changes in blood pressure may occur.

Avoid skin, eye or mucosal contact.

Immediately after exposure, wash the exposed skin with large amounts of fresh water.

Remove contaminated clothes that are in direct contact with skin.

In the case of accidental contact of the product with eyes, rinse with large amounts of fresh water. If symptoms occur, seek the advice of a doctor.

If pregnant women handle the product, special caution should be observed not to self-inject as uterine contractions and decreased foetal blood pressure may occur after accidental systemic exposure.

Advice to Doctors:

Medetomidine hydrochloride is an alpha-2 adrenoreceptor agonist. Symptoms after absorption may involve clinical effects including dose dependent sedation, respiratory depression, bradycardia, hypotension, a dry mouth, and hyperglycaemia. Ventricular arrhythmias have also been reported. Respiratory and haemodynamic symptoms should be treated symptomatically.'

I seem to recall someone telling me once that humans are more sensitive than dogs and cats to the alpha-2s we use.

RE: Needle stick injuries

Bob Russell — Wed, 12 Jul 2017 17:12:36 GMT

Needle stick injuries with human injections are a potential disaster. Hepatitis probably the main risk but HIV etc. Following an injury HIV prevention may be started and testing following.

Most of the time our injuries are a bit painful, nothing more! Very occasional infection plus a psychosomatic reaction perhaps especially if the ingredients are nasty.

I remember having light headed reactions to immobilon despite not having a needle stick injury. Just scary stuff to handle.

Some oily based products could lead to a trip to casualty but not so far!

I do not allow staff to re-sheath needles but do sometimes do it myself. Written protocols over each sharps bin make it clear what is acceptable. I do routinely change needles before injecting and all needles are removed by me into a sharps bin. Being tight fisted, I do get rid of syringes as pharmaceutical waste, not sharps, most of the time. It just happens to cost a lot less!

RE: Needle stick injuries

bob lehner — Wed, 12 Jul 2017 17:00:41 GMT

[quote user="Martin Atkinson"]

[quote user="bob lehner"](I once inadvertently stabbed a lady colleague in the bosom in this way[/quote]I'd be more worried why you were so close to this woman's bosom Bob than why you were carrying an unsheathed syringe.

Well it was quite prominent as I recollect.

[quote user="bob lehner"] I once stuck a needle with dom/torb/ket triple cat anaesthetic into my finger - my blood pressure crashed a few minutes later [/quote]I suspect that was more to do with a psychosomatic response more than any pharmaceutical reaction.

[/quote]

You might think so - but on that occasion definitely not - I was at home treating my own cat for an abscess - gave it DTK and pricked my finger. Didn't take much notice and certainly was not worried - gave it a squeeze and a quick wash under the tap.

10 mins later I felt decidedly odd - light headed and ataxic. i took my BP and the systolic reading was c. 100 which is way below my normal level when active. Sat down for a while and it gradually resolved. I'm quite sure it was the direct result of the needle stick.

[quote user="Martin Atkinson"]

[quote user="Evelyn Barbour-Hill"]To my common sense it seems that a needle with a sheath on is safer than a naked one.[/quote]Of course it is but am I being thick or is everyone missing the point here which is that you shouldn't re-sheath needles because of the risk if sticking yourself in the process. The needle should be disposed of in a safe manner after withdrawing the drug from the bottle and then put on a new needle for injection with the sheath still on if you need to carry it. There should be a sharps box in every location you are likely to with withdrawing injectables or actually injecting them. I know we don't all do this but it is what we should be doing.

I'm surprised that Bob with his 'policing' role is advocating doing anything else.

[/quote]

Umm - I think that is what I was saying?

RE: Needle stick injuries

Martin Atkinson — Wed, 12 Jul 2017 13:18:41 GMT

I'm surprised that Bob with his 'policing' role is advocating doing anything else.