Top EMS Game Changers – #10: Safety sharps
The advent of these specialty devices provided protection against unintended needle sticks, one of EMS providers' greatest risks
When AIDS, hepatitis and other bloodborne pathogens emerged in the 80s as invisible killers, dirty needles were widely considered one of EMS providers' greatest risks.
Through the mid-‘90s, disease prevention consisted mainly of personal protective equipment and annual classes on how not to get infected. The curriculum justifiably portrayed uncapped needles as accidents waiting to happen; students were urged to deposit used sharps in suitable containers.
Those of us on the trailing edge of the pre-PPE generation regularly broke that rule. We considered floors, mattresses, bench cushions and even drug boxes temporary receptacles for sharps, and viewed recapped needles as safe, interim substitutes for centralized hazmat containers. Sometimes we’d even leave contaminated needles uncovered until we could deposit them in wall-mounted units out of reach. It was that sort of blatant sharps mismanagement that led to my first needle stick.
Lucky trumps stupid
I’d started an IV from a kneeling position in the ambulance, then laid the used sharp on the bench while I secured my line. By the time I’d adjusted the flow, I’d forgotten about the pointy virus reservoir I’d put aside. I stood up to print an EKG, leaned back on the bench, and felt the needle pierce the palm of my right hand.
I was more afraid of reporting the incident than of catching a disease, so I surreptitiously swabbed the site with alcohol and said nothing about it. Several years later, after multiple pre-employment physicals had confirmed I was ridiculously healthy, I stopped worrying about getting sick.
No doubt many of you with a few decades in EMS have similar stories, which proves education alone isn’t enough to prevent carelessness. That’s why "safe" angiocaths – over-the-needle IV catheters with protective mechanisms – started to appear in drug bags 20 years ago.
Sticks that click
Basic angiocaths have a needle attached to a clear plastic flashback chamber that fills with blood when the needle pierces a vein. Entering the vessel just far enough to manually advance the catheter, withdrawing the needle while stabilizing the catheter and tamponading the vein, then securing the IV line are fine-motor skills paramedics and some EMTs master after lots of practice.
Most paramedics I know consider the size, shape and mechanism of sharps to be matters of personal preference influenced during primary training. Ask 100 medics from my generation if they willingly swapped familiar, unprotected angiocaths for newer devices, and I bet at least 50 would say no.
Each of us tends to favor a particular brand until our agency stops stocking it, or we start missing IVs – a cyclical eventuality that afflicts most of us. It was after one of those frustrating streaks I started trying these alternatives to conventional sharps:
Tab and telescoping barrel: The first protected angiocath I used has a telescoping barrel that sheaths the needle as you advance the catheter into the vein. When you hear a click, the catheter is locked as far forward as it’s going to go; then you separate the barrel from the catheter hub and secure your line.
A distinctive feature of this model is the tab at the proximal end of the barrel. Pushing that tab forward to advance the catheter is supposed to be easier than dragging the catheter hub.
Push-button needle retractor: After grasping the hub of this unit and advancing the catheter into the vein, you click a barrel-mounted button to withdraw and sheath the spring-loaded sharp. Due to the vacuum in the catheter caused by rapid retraction of the needle, it wasn’t unusual for early units to suck blood through the catheter and spew it at the user – a self-defeating characteristic of "safer" technology.
I worked with an early vendor of this unit to resolve another problem: Catheter hubs would often adhere to barrels, making it difficult to advance catheters into veins. I missed a bunch of IVs before I realized I had to rotate the hub around its male receptacle prior to each stick.
Hub-based needle clasp: The newest and least intrusive of second-generation angiocaths, this unit attaches a metal clip to the tip of the needle as it’s withdrawn through the catheter hub.
Some angiocaths now come with one-way valves that prevent blood from pouring out of the hub once the needle is withdrawn.
Other sharps: Syringes are safer now, too, with integrated needle guards or needleless tips. The latter are ideal, provided your patient’s administration set includes an appropriate port.
After experimenting with pretty much every kind of shielded needle, I still preferred the feel and simplicity of old-fashioned sharps. As my employers began to mandate more modern assemblies, though, I had no choice but to convert. After a few months, the brand didn’t matter.
Looking ahead, the medical industry’s growing reliance on oral and nasal medications should provide even more protection against unintended needle sticks than the most sophisticated invasive devices.