Is your ED ready to go needleless?’

Needlesticks were cut by 60% in just 2 months

 Harborview Medical Center in Seattle reduced its needlestick injuries by 60% shortly after the facility went "needleless" in 1993, reports Darlene Matsuoka, RN, BSN, CEN, CCRN, ED clinical nurse educator at Harborview. The following changes were made:

• An all-in-one containment is used with IV start devices

• An adaptor is used to hook up one IV line with another.

• One-way valves on "Y" type IV extension sets allow the pushing of medications into the IV line without needles.

Needlesticks dropped by more than 60% after only two months after the switch to a needleless IV tubing system and quick-cath IV system that sheaths the needle by pulling it back into an attached sleeve, Matsuoka notes.

A third of the decrease in needlestick injuries was due to not using needles taped into IV tubing for "piggyback" medications, says Matsouka. "The kind of exposure is low-risk," she says. "Even though it is with a hollow-bore needle, the needle is not in direct contact with the patient’s blood."

Two products are used to prevent piggyback sticks: The Quick-Cath Abbocath (manufactured by Abbott Pharmaceuticals, in Abbott Park, IL) and the Insyte Auto Guard shielded IV catheter or Saf-T-Intima IV catheter safety system (both manufactured by Becton Dickinson, in Franklin Lakes, NJ).

Either product works well, but nurses may have individual preferences, says Matsuoka. "The quick-cath IV inner needle has a bigger tab to push and thread the catheter in, then gets pulled back into a sheath before hooking up," Matsuoka explains.

The Insyte Auto Guard device is sharper and pierces the skin more readily, she notes. "The push button to retract the IV needle is easy to use but does not allow for last-minute adjustments," she says. "More pressure distal to the catheter tip is needed to prevent backflow when hooking up."

Matsuoka notes that patients transferred from other facilities sometimes have the Clave needleless IV tubing system (manufactured by ICU Medical, in San Clemente, CA). "The Luer-lock screw-in convenience makes the IV system easy to use," she says. "However, if the valve is poked instead of screwed in, the system leaks."

The highest-risk procedures involve using hollow-bore needles in contact with blood or body fluids, such as venipuncture or IV placement, Matsuoka notes. "A common error is the accidental poke with a needle during wound preparation with lidocaine, if the patient moves or jerks away," she explains.

Other punctures that are not as high-risk, but do occur in the ED, include suturing (solid needle), and incision and drainage (use of a scalpel), says Matsuoka. "A nurse’s exposure can be from cleaning up after a physician and getting stuck with a needle left behind on an instrument tray," she says. "Our ED has a rule that everyone must take care of their own sharps!"

Needlesticks from IV starts are almost nonexistent since the needleless system went into effect, says Matsouka. "The ED has not had one for several years," she says.

Needles are still used to deliver medications to access a conventional Y-site in an IV line, notes Matsuoka. "We use vacutainer needles to draw our initial labs if no IV line is needed," she says.

Most ED needlestick injuries occur from the vacutainer draws, suture needles, or when the physician is prepping the wounds with lidocaine, Matsuoka reports. "The occasional recapping of needles occurs with the medical students, and hematocrit tubes sometimes break," she says.

Track the number of exposures on your unit on a monthly basis, recommends Karen Daley, RN, MPH, president of the Canton-based Massachusetts Nurses Association. "If your numbers are rising or not going down, you need to reassess your approach, both from the standpoint of devices being used and employee education and training," she says.