| Engineering Controls Engineering Controls are devices which isolate the worker from the hazard of exposure.Examples include: Self-sheathing needles Sharps disposal containers Disposable resuscitation bags Microbiological safety cabinets Handwashing facilitiesProper use of engineering controls in your workplace will help protect you from bloodborne pathogens. | View Page |
| Spread of HBV In The Community HBV is spread in the community through: Sexual contact. Drug abusers sharing contaminated needles. An infant's exposure to its mother's body fluids. | View Page |
| Sharps A sharp is any object which can penetrate the skin.Examples include: Needles Scalpels Broken glass About 800,000 needlestick and sharps injuries occur in the U.S. healthcare workplace each year! It is important to handle and dispose of sharps properly. | View Page |
| Sharps DOs and DON'Ts DOPlace all needles and other sharps in puncture resistant sharps disposal containers as soon as possible after use. Use extreme caution or a safety device when removing a scalpel blade from its handle.DO NOTRecap, bend, shear, or break needles. Remove needles from needle holders or disposable syringes. | View Page |
| Needles, safety needles, and needleless systems Most hospitals use some form of needle/holder combination that incorporates a needle safety device. This device has a mechanism that will cover the needle after use. It must be activated as soon as the task is completed. The device that is pictured here is just one of many options that are currently available. There are also needleless systems that use special adaptors which attach to some intravenous lines that will permit blood to be obtained without the use of needles. | View Page |
| Which of the following are considered engineering controls? | View Page |
| Discussion All biohazard needle disposal containers are marked with a “full” line at about ¾ of the box’s volume. Therefore, needles should never be sticking out of the top of the container. Julie should never have attempted to put the needle into an overly full container. The needlestick safety and prevention act requires the use of butterflies with built in safety devices. However, they are only effective if properly activated. When disposing of a butterfly needle, hold its “wings” with one hand, and the hub at the opposite end of the tubing with your other hand to prevent the needle from recoiling. Butterflies should be used with extra caution since they are the number one cause of needle stick injuries.Relevant topics:Needle disposal, Sharps disposal containers, Butterfly needles with safety 1, Butterfly needles with safety 2, Needle-stick injuries, Built-in safety features, Angel Wing™ safety butterfly, Punctur-Guard™ safety butterfly | View Page |
| Discussion The phlebotomist should always carefully observe the patient for clues about his mental and physical condition. In this case, the patient verbally expressed her fear of needles. In other cases, such fear may be expressed on the patient’s face or through other clues. It may help to engage apprehensive patients in conversation during the venipuncture to keep their mind off the procedure.As soon as the patient stated that she felt faint, the procedure should have been terminated. If a sitting patient faints, placing her head between her knees will help to revive her. Make sure the patient does not injure herself. Ammonium (smelling) salts, if in use at your institution, should be used cautiously, since they can be irritating. Get help from the nursing staff or a physician. Stay with the patient at least 15 minutes. The patient should not leave the area for at least 30 minutes. Make sure other appropriate institutional procedures are followed after fainting.Relevant topics:Fainting, Fainting continued | View Page |
| Case A phlebotomist at an outpatient drawing station prepares to collect blood from a patient who is scheduled for surgery the next day. The patient tells the phlebotomist that she is afraid of needles. The phlebotomist assures the patient that everything will be fine. He seats the patient in a phlebotomy chair. He talks the patient through the beginning of the venipuncture and she seemed to be doing fine. As the second of four tubes is being drawn, the patient suddenly blurts out that she fells very dizzy and is going to faint. | View Page |
| Single draw needles Single draw needles are of the type that fit on a syringe, and can be used only to fill the syringe to which they are connected.
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| Butterfly needles with built-in safety features continued Two examples of butterfly needles with built-in safety devices are shown.The Punctur-Guard™ (Bioplexus), shown above, uses an internal blunt needle which is activated after blood is drawn. The activated device showing the blunt internal needle is shown in the inset on the upper right.
The Angel Wing ™ (Monoject), is activated by sliding a safety shield over the needle after venipuncture.
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| Multiple draw needles Multiple draw needles are used with vacuum collection tubes.They allow the collection of blood into multiple vacuum collection tubes during a single venipuncture.
They have a retractable sheath over the portion of the needle that penetrates the blood tube.
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| Multiple draw needles with built-in safety features. You will be required to use multiple draw needles with built-in Safety features.
One example is the Puncture-Guard™ (BioPlexus) needle, which uses an internal blunt needle (detail above) that is activated with forward pressure on the final blood tube prior to withdrawal of the needle from the vein.
Refer to your institution’s and the manufacturer’s procedure manuals before using these devices.
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| Needles Needles come in many sizes.
The size of the needle is called the gauge.
The larger the needle, the smaller the gauge number.
For most routine venipunctures, a 21 or 22 gauge needle is used.
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| Needles with built-in safety devices You will be using needles and/or needle holders with built-in safety devices.
Various such needles are on the market.
Remember that you must still activate the safety device to get the protection offered.
So careful attention to what you are doing is still one of the best ways to protect yourself against needlestick injury.
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| Butterfly needles Butterfly needles, also known as a winged infusion set, are often used for difficult venipunctures including pediatric venipunctures.
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| Butterfly needles continued Butterfly needles may be used with a syringe or a holder and vacuum collection tube system.
They are usually 21, 23, or 25 gauge.
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| Butterflies with built-in safety features You will be using butterfly needles with built in safety features.
Butterfly needles are the number-one cause of needlestick injuries, so proper use of their safety devices is critical.
Their use is described in greater detail in the section on butterfly needle blood collection.
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| Butterfly needle - Butterfly needle collections Butterfly needles (also known as a winged infusion set), are available in smaller gauges, and are used to draw venous blood from children, and adults with difficult veins.
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| Butterfly needle - Butterfly needles with built-in safety features You will be using butterfly needles with built-in safety device. The safety device must be activated upon completion of the blood collection.You will be using butterfly needles with built-in safety device. The safety device must be activated upon completion of the blood collection.The Angel Wing™ (Monoject) safety butterfly is shown here.
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| Heelstick - Pediatric collection procedures: Introduction Veins of small children and infants are too small for venipuncture;Safety Lancets are used to puncture the skin and collect capillary blood.Butterfly needles may be used to collect venous blood in older children.
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| Butterfly needle - Butterfly needle collections continued Butterfly needles come attached to a small tube which may be connected to:An evacuated tube holder, orA syringe. | View Page |
| Butterfly needle - Butterfly needles and needle-stick injuries Butterfly needles, because of their flexibility, are the number one cause of needle-stick injuries among phlebotomists.Use extra caution when using butterfly needles. | View Page |
| Equipment These items are needed to obtain a blood culture specimen :Gloves (sterile if available)Alcohol pads and sterile gauze padsTourniquet and iodine swabsBlood culture bottlesSyringes, needles, and/or evacuated tube system. | View Page |
| Hazardous waste disposal All needles & other sharps must be disposed of in approved sharps disposal containers.
Other contaminated waste must be discarded in an appropriate red biohazard bag or waste receptacle. | View Page |
| Needlestick safety and prevention act The Needlestick Safety and Prevention Act was passed by Congress in November 2000.
This law modifies the OSHA Bloodborne Pathogens Standard to require that health-care institutions use only needles and other sharps which have engineering controls and design features to help prevent accidental sharps injury.
Health care institutions must update their exposure control plans to reflect these changes.
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| Needles - What's the Point? Needles that are used for venipuncture are available in a variety of lengths and diameters. The diameter of the needle is referred to as the needle gauge; the larger the diameter of the needle, the smaller the gauge number. The image on this page illustrates the relative gauges of needles that are available for venipuncture. Needles that are routinely used for venipuncture are available in 3/4 inch, 1 inch and 1 1/2 inch lengths. The phlebotomist determines the gauge and length of the needle to use for a venipuncture after assessing the vein. | View Page |
| Needles and Patient Safety All needles are single use. That is, every needle is immediately discarded in a sharps container after one insertion. If you suspect that you inadvertently touched anything with the needle prior to inserting the needle into the patient's vein, the needle cannot be used; the safety device must be activated and the needle discarded.NEVER remove a needle from a patient and reinsert into another vein; this could put the patient at risk for infection. | View Page |
| Don't Get Stuck Without It Current practice mandates the use of safety devices on all needles. These devices are designed for ease of use and disposal. Tampering or disabling any safety mechanism is forbidden and unprofessional. If the safety mechanism has been compromised, you are putting yourself, the patient and your coworkers at risk of injury. | View Page |
| Do It Right the First Time All sharps, including needles with safety devices activated, must be immediately placed into an approved biohazard sharps container. Containers with rigid sides must be puncture proof and leak proof. The container must be tightly closed and discarded when 3/4 full. Biohazard waste other than sharps should be properly disposed of in clearly marked biohazard bags or containers according to site protocol. | View Page |