Saturday, September 17, 2011


"He who is not every day conquering some fear has not learned the secret of life."
-Ralph Waldo Emerson

One of the biggest fears that one must conquer in order to work as a physician is the fear of needlestick injuries.  Laymen focus on the risk of contracting HIV, but it's actually fairly hard to contract HIV from a needlestick unless you inject yourself with a few milliliters of blood.  No, the really scary disease you can contract from a needlestick is hepatitis C.  It's a much more contagious virus, and like HIV, there is no cure, and no vaccine.  So if you're going to be afraid of blood-borne illnesses, hep C is the one you want to watch out for.

I've been stuck twice so far.  Once was during my gynecology rotation in medical school.  I was scrubbed in for a hysterectomy and holding a retractor for the surgeons.  The gynecology fellow wasn't paying attention when she set down an instrument she was using, and she stabbed me in the finger with it.  Fortunately, it didn't break the skin, and when I called the exposure hotline, they stated that I didn't need to do anything further.  Also, since the instrument was solid and not hollow-bore like a needle, and I was double-gloved, that reduced the risk of blood exposure even further.

The second time was this past week.  I was working overnight, and I had a patient with an infected Bartholin's gland cyst.  I had drained the pus from the cyst, and I was inserting a Word catheter to help keep the incision open so that it could continue to drain.  The catheter has a balloon on it, which gets blown up with several milliliters of air using a syringe and needle in order to keep it from falling out of the wound after insertion.  Most of the needles we use in the ED are safety needles, but this was the needle that had come with the Word catheter kit, and it was a regular old-fashioned needle with no safety lock on it.  Everything was going fine until I finished blowing up the balloon and went to remove the syringe and needle from the catheter.  The needle came out with more recoil than I expected, and I stabbed myself in the thumb.

This wasn't a little poke like what happened to me in medical school.  This was a real stick with a dirty hollow-bore needle covered with pus and blood that made a visible puncture wound in my thumb.  I washed the area well with soap and water, and told my attending that I had stuck myself.  We called the exposure hotline, and I had labs drawn for hepatitis B, hepatitis C, and HIV.  Fortunately, the patient consented to be tested for the viruses as well, and the nurse drew her labs, too.

After my shift ended around 9AM, I went to the employee health office to fill out the paperwork and be counseled by a nurse.  She reassured me that it was unlikely that I had injected myself with blood, as the syringe itself contained air, and the blood and pus were only on the outside.  Also, she would contact me in a day or two to let me know the results of the tests. The next day, she called to tell me that the patient tested negative for hepatitis C and HIV, and so did I.  (I did test positive for hepatitis B antibodies, but that's a good thing, because I have had the full series of immunizations for hepatitis B.)  So it was a big relief.

Thinking about this series of events, I decided that the next time I have to use a Word catheter kit, I will inflate the balloon using a safety syringe.  We have plenty of them in the supply room, and there's no law that says I can't just dispose of the unsafe syringe that comes in the kit without using it.  I also have to accept that, no matter how careful I am, there is always a risk of being stuck.  The only way to avoid any chance of it happening, is to stop taking care of patients.

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