Needle-stick exposure in the health care setting: do not forget hepatitis C!
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A 19-year-old, healthy nulliparous woman developed an intracranial subdural haematoma after unintentional dural puncture in connection with epidural analgesia for labour pain. The haematoma was evacuated and the patient recovered completely. Anaesthesiologists and obstetricians should be aware of this rare but potentially dangerous complication to epidural analgesia.
To determine how often US ED practitioners have prescribed HIV post-exposure prophylaxis (HIV PEP) and to discern how willing they are to offer it to patients, the authors surveyed 600 ED practitioners attending a national conference. According to their self-report, 11% had taken HIV PEP themselves. Sixty-eight percent had prescribed HIV PEP at some time. Of these, 92% had treated needlestick-injured health care workers, 48% sexual assault survivors, and 49% nonhealth care needlestick-injured persons. ED practitioners were more willing to offer HIV PEP after exposures to HIV-infected or high-risk sources than unknown or low- risk sources, as well as after sexual assault than consensual sex. Female practitioners, those who had themselves taken HIV PEP, resident physicians, and ED practitioners with fewer than 6 years of clinical practice were generally more apt to offer HIV PEP. Educational campaigns appear to be necessary to help ED practitioners determine when HIV PEP is appropriate.
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Disposal of sharp instruments and needles ("sharps") is an ongoing problem in the emergency department (ED). Cleanup and disposal of needles and other sharps after a procedure is the responsibility of all ED personnel, including physicians. Simple cleanup techniques are explained and illustrated. All techniques are designed to be done (1) without exposing physician to a needle stick, (2) with equipment readily available in the ED, and (3) with containers readily seen by those disposing of the sharps and other materials. Adherence to these cleanup procedures should help lessen the problem of sharps and disease exposure in the ED.
The National Fire Protection Association has developed standards for glove puncture resistance using a metal puncture probe. Biomechanical performance studies have demonstrated that glove puncture resistance to the probe is significantly greater than that of the hypodermic needle, suggesting that these standards have no clinical relevance. These standards give a false sense of security to health care personnel and sanction the production and use of gloves that give inadequate protection. The result is potentially harmful for medical personnel.
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After having a retrobulbar injection for anesthesia before cataract surgery, a patient developed dysarthria. This was the presenting sign for penetration of the optic nerve sheath by the retrobulbar injection, with subsequent brainstem anesthesia. Thereafter, the patient demonstrated cranial nerve dysfunctions with tongue deviation, tachycardia, hypertension, and contralateral sixth and third nerve palsies. I believe this is the first documented case in which dysarthria is the presenting sign for brainstem anesthesia resulting from a retrobulbar injection.
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BACKGROUND: Current Occupational Safety and Health Administration (OSHA) guidelines mandate the use of safety needles when allergy injections are given. Safety needles for intradermal testing remain optional. Whether safety needles reduce the number of accidental needle sticks (ANSs) in the outpatient setting has yet to be proven. OBJECTIVE: To determine the rate of ANSs with new (safety) needles vs old needles used in allergy immunotherapy and intradermal testing. METHODS: Allergy practices from 22 states were surveyed by e-mail. RESULTS: Seventy practices (28%) responded to the survey. Twice as many ANSs occurred in practices giving immunotherapy when using new needles vs old needles (P < .01). The rate of ANSs was roughly the same for intradermal testing with new needles vs old needles. CONCLUSIONS: These findings further question whether OSHA's guidelines for safety needle use in outpatient practice need revision and if allergy practices might be excluded from the requirement to use safety needles.
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Acupuncture has become a widely used treatment modality in various musculoskeletal pain conditions. Acupuncture is also shown to enhance blood flow and recovery in surgical flaps. The mechanisms behind the effect on blood flow were suggested to rely on vasoactive substances, such as calcitonin gene-related peptide, released from nociceptors by the needle stimulation. In a previous study on healthy subjects, one needle stimulation into the anterior tibial muscle was shown to increase both skin and muscle blood flow. The aim of this study was to examine the effect of needle stimulation on local blood flow in the anterior tibial muscle and overlying skin in patients suffering from a widespread chronic pain condition. Fifteen patients with fibromyalgia (FM) participated in the study. Two modes of needling, deep muscle stimulation and subcutaneous needle insertion were performed at the upper anterior aspect of the tibia, i.e., in an area without focal pathology or ongoing pain in these patients. Blood flow changes were assessed non-invasively by photoplethysmography (PPG). The results of the present study were partly similar to those earlier found at a corresponding site in healthy female subjects, i.e., deep muscle stimulation resulted in larger increase in skin blood flow (mean (SE)): 62.4% (13.0) and muscle blood flow: 93.1% (18.6), compared to baseline, than did subcutaneous insertion (mean (SE) skin blood flow increase: 26.4% (6.2); muscle blood flow increase: 46.1% (10.2)). However, in FM patients subcutaneous needle insertion was followed by a significant increase in both skin and muscle blood flow, in contrast to findings in healthy subjects where no significant blood flow increase was found following the subcutaneous needling. The different results of subcutaneous needling between the groups (skin blood flow: p=0.008; muscle blood flow: p=0.027) may be related to a greater sensitivity to pain and other somatosensory input in FM.