Saturday, June 12, 2010

The Needle and the Damage Done?

One of the most onerous tasks lately as department head (or site leader as we say in newspeak) has been the implementation of what our leaders call "Safety Engineered Devices". These are essentially needles that cap or blunt themselves automatically to prevent needle-stick injuries.

As an anaesthesiologist I should be in favour of these devices. After all for a living I for the most part stick sharp things into people, take them out and dispose of them. As such I am at high risk for needle-stick injury. In fact I blogged about my last needle-stick. Early on in my career I read a depressing article where someone calculated a 1 in 3 chance of an anaesthesiologist being infected with HIV during his career. This gloomy article was based on 3 needle-sticks a year and assumed a population incidence of HIV that we have fortunately never reached in North America. Wearing gloves does not of course prevent needle-sticks, it may in fact increase the risk.

Our most recently foray into safety actually originated with our Ministry of Labour which in our province is in charge of Occupational Health and Safety not the Ministry of Health. Legislation was passed and we are now approaching the July 1 deadline. This has meant multiple emails, multiple meetings and I cannot pass anyone in my department in the hall without getting an earful.

Why do we hate these so much? Most of these devices were introduced 3-5 years ago. The hypodermic needles in order to have their built in blunting or capping devices are incredibly bulky. This is not much of the problem with the larger needles that we use to draw up drugs (although we hate them too). The smaller needles that we use for infiltration or occasionally nerve blocks are cumbersome to use, and the extra bulk often makes it difficult to see the needle tip, something most of us like to see as we are sticking it into somebody. Fortunately with some needles it is possible to break of the capping device which I do, although I was informed last week, I can be fined for doing so.

Worse are the intravenous needles. These either come with a spring loaded blunting device which shoots up the needle hopefully after (but frequently during) the intracath insertion. The other variety has a spring loaded device that withdraws the needle back into the hub like a reverse switchblade.

3 years ago we were given the first variety. Even accounting for a learning curve, they were terrible. The needles were blunt, the catheter did not slide easily, they were bulky and the flashback chamber was small. Within days because of complaints the old IVs appeared in the OR but the nurses on the floors were forced to use them which meant that patients came down to OR with bandages all over their arms from failed attempts.

With the deadline looming however, a better safety IV appeared, the BD Insyte with its retractable needle. While they are a little bulky, they seem to be something I at least can live with especially as we already use the old BD Insytes and are used to them. We are assured we can use them, I suspect they may suddenly disappear in a year or so and we will be left with a less user friendly needle.

Fortunately, as there is no "safety engineered device" available, epidural, spinal and nerve block needles are for now exempted. Interestingly enough acupuncture needles are not. It is possible to apply for an exemption which I did last week for all our "dangerous" sharps and we are assured that these exemptions will be granted although only for six to 12 months at a time which should help the pulp and paper industry.

It is only a matter of time before the companies that make both types of devices realize that there is no point in manufacturing a cheaper device when they can with the government's blessing sell a much more expensive device.

More ludicrous has been the search for a safety engineered scalpel. With 3 weeks to go to the deadline, no such satisfactory device, has been found and as far as I can see they aren't even trialing one. I was going to suggest that they just use box-cutters.

One issue nobody has raised so far is the cost of all this. I learned this last week at a meeting. The SED hypodermic needles currently cost 26 cents a unit versus 2 cents a unit for the old device. I suspect the gradient for the intravenouses is even higher. These may be only a matter of a few cents however think how many needles get used every year. For example in our late (and I am told futile) H1N1 vaccination blitz SED needles were exclusively used. So say in our province one million people were vaccinated, the means that $260,000 rather than $20,000 was spent on needles alone. At the meeting I was informed that while we are trying to cut healthcare costs in other areas, when it comes to SED's money is no object.

I like to protect myself and don't really like the needle-stick experience I seem to get every couple of years with its paperwork and blood drawing. Worse I would hate to have a nurse or other colleague stabbed by one of my needles. I wish that this whole initiative was driven by a concern by worker safety but I think it is being driven by an occupational health and safety industry that is farther and farther removed from the realities of the workplace.


burnttoast said...

The driver behind the last set in our OR was the wicked witch of an OR director, who got a bee in her bonnet and decreed that "hospital policy" demanded a safety needle for everything possible. The system to access vials was particularly laughable. It had a miniature screw driver that had to be held just right to puncture the vial, often flipping out of hand onto the floor, requiring, yes another. The IV cath sets were horrid. I was struggling to place an IV in a rather large patient (who had already been stuck by RNs multiple times), trying to be cool and reassuring. The vein was lost in the process of engaging the safety device, not an uncommon problem. "Those new catheters really suck, don't they?" spoke the patient. She was an RN, which I hadn't known until then. Of course , the other part to this story was, when we went to the cath lab, the cardiologists got to use real needles!! Anything they want, I guess..What fries me, is no one seems to care that getting IV access is life and death, and deliberately making the process harder puts the patient at risk. Why can't they make one that works!! Oh, and what do you thing about TEVA getting out of propofol, saying "There's not any money in it."!!!

Bleeding Heart said...

It would be nice if we only have to deal with a wicked old witch. Unfortunately the SEDs are government mandated.

I had heard rumors propofol problems in the US. Our generic propofol is a different company and our tort law is different.