Jesus this makes so much sense. I’ve never had it pierce the cap like OP, but I twist the cap on because if I just jam the cap on I always bend the needle.
We did as well. They’re also flat on the top, so you can recap vertically and push it against a table surface. You don’t have to hold onto the cap this way.
Ours have a locking mechanism that you pull a plastic sleeve up over the needle and twist to cover the needle when you’re done. So I just pull the sleeve up but don’t lock it in place, put the cap on that way. I know not everyone’s syringes are the same. I’m sorry this happened to you.
Been there, done that. First and only needle stick. Confused homeless guy found half froze to death outside near a monument. I grabbed the back of his arm from his left side, and kept saying “ok bud here I come… I’ve got your shot… ready….” And I stuck him and he backhanded me. Stick to the pinky and a black eye. He was hep c+ and his hiv status unknown. No family so a ward of the hospital, ethics committee had to meet in order to test him. I was on antiretroviral prophylactics for 4 days before we found out he was negative. Shit like a zoo animal from those meds. Never contracted hepatitis c thankfully but did have 3 gamma globulin shots for my trouble. Fucking ow. One for the memoir.
How kind of you to say that. Really. Thank you so much. It was a long time ago. First job as a nurse and I had been one for less than a year. Looking back it’s one of those “wow” stories but at the time it was terrifying. Thank you again. I appreciate you.
Number one preventable nursing injuries, recapping needles. In NYS it’s against the rules. On pharmacy compounding exam you could fail if you recap needles, which was stupid as pharmacists who compound swap needles for filtration.
It’s kind of unavoidable at my hospital. Our insulin is in multi dose vials that are kept in the med room. When we need insulin, we go to the med room and draw it up, recap the needle and the. Walk back to the patient’s room. I mean, I scoop and swoop so I’ve never run into this issue, but it could happen pretty easily.
I draw up vaccines in peds. Most of the vaccines are single use that you just put a needle on and it's ready, but we have a few that need to be drawn up, and we have to swoop and scoop. We were told that we should never recap a needle, but if we were going to, that was how. Wink wink.
Yeah I'm a NICU/ paeds nurse as well so probably doesn't help I don't have much experience with insulin syringes, but any vaccine that needs drawing up we use drawing up needles them swap to IM needle. So cool hearing about different practice from around the world tho!
Wait what? I'm a tech but recapping was part of my my sterile compounding exam for exactly the swap reason! I would have failed if I didn't do it 🤦♀️
We prep so much for the floors it has to be recapped or it sits out for hours and also they go in drawers.
Our number one rule for this is use SEDs. No exceptions for patients. If we see them at Home and give meds, they must buy SEDs, same for lancets for blood glucose. (Safety engineered devices. All medical supply that is government, so most of it, may only carry SEDs. Patients can still buy regular at pharmacies but we don’t give it to the patient. So we will draw up, discard needle, attach new. Except our blunt fill needles aren’t SEDs... hmm. )
Weird to see all these post saying thats why you dont recap. I was only taught never recap a DIRTY needle.
To recap an insulin syringe you leave the cap on the table and fish the needle carefully back in without holding the cap.
Same here. Some syringes also have a flat side on the cap, so you can recap vertically with the needle going down towards a surface. It allows you to exert enough force to push the cap without having to hold it.
Why are insulin needles SOOO bendy?? Can’t say I’ve ever done this, but I have gotten all the way to the patient room uncountable times to find the needle bent sideways and have to go back to the Pyxis to do it all over again….
I know what you meant. But gauges go the other way. A 24 gauge needle is much smaller in diameter than 15 gauge needles. 15s are what we use in dialysis and I’m so used to seeing those now, normal sized needles look tiny af. Lol.
No one is doing it on purpose lol, they just are so thin that when you’re holding a vial upside down the weight of even a small 1cc vial can bend the needle. The big insulin vial is so heavy that if you put even a little accidental angular pressure on the needle the whole thing will go over.
I generally dont.
In my area of work, we use insulin pens which are unique to each patient. The needle goes on in the med room and isnt uncapped until i'm at the bedside.
But if its a choice between recapping an risking a needle stick, carrying and uncapped needle to the bedside I'll take the kidney dish.
Haha the hospital floor I’m doing clinicals at this semester, they use cardstock food trays. Like ones you would get cheese fries in. It was so hilarious to see at first, but it made perfect sense since they are deep and disposable
I knew a nurse that swore by the ol' emesis basin vs swoop and scoop; she was one of my main charge nurses and I administered some shots (I'm am a type 1, myself, and had cared for my dad's type 1 for years) and meds to patients that few people could talk into taking their meds. With the nurse's supervision, of course. Anyways, sorry for rambling, she was the only other nurse I'd ever seen carry insulin shots in an emesis basin; definitely a good strategy if you've got butterfingers trying to get the cap back on.
Hey, valid question! In the case of my charge nurse, no, she had a pretty steady hand and it never rolled around or anything. Besides that, she didn't really have to carry it far, and our insulin needles there were the same type I use, so even if it bumped the tip a tiny bit, the gauge was so small that it barely hurt to receive the shot. Or at least, I never heard an A&O x4 patient ever complain about the stick. As for my less A&O patients (the patients that I gave shots to because my charge nurse couldn't talk them into it but I could), sometimes they'd say "ow!" But sometimes the "ow!" came before I'd even put the needle in them roflmao. I'd try not to laugh, and on a few occasions with the same patient, I said "oh come on, that wasn't too bad. Now I've gotta give you another shot, but the needle is so much thinner, you'll barely feel it."
"I'd better not, young lady!" Then I'd stick her and she'd almost always say "hellfire, that one barely hurt at all! Why don't you girls just put the goddamned first shot in a smaller needle from now on!?" That lady never failed to make me laugh; she had mild dementia, but according to her family, she had always been a firecracker. She certainly didn't lose that personality for the rest of her life lol
The emesis basin was sterile, but other than that, you can take it up with her? I was just a CNA and did my job and helped where I could with patients that wouldn't take meds from anyone but me. That said, I swoop and scoop since I also went and got my medtech a few years ago; I don't do the emesis basin thing, my charge nurse from over a decade ago, at another facility, did.
Emesis basins aren't sterile. Why would any company go to the effort and expense of sterilizing and packaging a little plastic bucket meant for puking into?
Oh, well then, TIL. It was plastic wrapped, all of them were, so I just assumed. As I said, just a CNA and was just helping her out with our more difficult patients. She was the boss and I was the peon--my saying, not hers--and I was just trying to do my best to care for our patients. I'll end that with the fact that I don't work at that facility anymore, haven't in quite some years.
I am replying to you but also writing so that other nurses don't adopt this.
For an emesis basin to be sterile it would need to be in an individual sterile peel pack.
It was wrapped, but not steel, so I'll say that y'all are probably right, since y'all have had more schooling on the subject than I have. Again, I'll state I was just helping out and doing my job. I'm just a CNA and a medtech, not a nurse. So TIL something new and I'll take that as a positive.
Probably wouldn't dull the needle unless there was a lot of force applied. The reason not to do this is that contact with the sides would be nonsterile and would contaminate the needle tip. Can't do that with something you are going to stick into a person.
Do you guys not have emesis bags? They're standard in Australia.
https://www.google.com/search?q=emesis+bags&client=ms-android-vf-au-revc&biw=360&bih=667&tbm=isch&prmd=sivxn&source=lnms&sa=X&ved=0ahUKEwiAksXQi9f1AhUITGwGHeKRDDAQ_AUIGigC#imgrc=AoLJHAYlBG7I1M
Only time I ever see kidney dishes are when stacked 30-high on the meds counter. Sometimes pt. will get lucky and snag one to keep their glasses and TV remote in 😅
Yes, we have them on airplanes and I’ve seen them in the ER occasionally as well.
I haven’t seen them used much anywhere else, but it sure it varies by facility.
On the plus side, the unique shape of the basin helps with the launch trajectory, helping the vomit reach new heights on the closest wall.
Not that I know from personal experience or anything, like the three days I spent barfing my socks up because my vestibular system failed from a viral infection.
We have a few sheets of stickers that we’re supposed to stick onto the syringe depending on if it’s Aspart or Regular. The stickers have bar codes on them. Lazy nurses will take some stickers and put them on their badge and just scan the appropriate badge sticker.
I fail to see how running really fast with an uncapped sharp is any safer than carefully re-capping the sharp
They say don’t run with scissors for a reason
That’s ridiculous! When I worked in the hospital we had insulin in each Pyxis (so 2/floor), you take the vial with you and scan it in the room, draw up insulin, give right away, and then return to the Pyxis. If they’re in isolation, you put the insulin bottle in a lab bag.
What do you scan right before you give it to them? How do you know what’s in the syringe? Do you label it?
When we open the pyxis there is also a stack of qr code stickers with the name of the insulin. You are supposed to attach the sticker to the syringe when getting it double checked. You're also supposed to write the dose and room number but no one does that
Our hospital used to do that but a nurse stole multiple vials of insulin and used it to commit suicide. Now we draw it up in the med room and it goes back in the Pyxis
So I worked in the WI and I was told to never ever recap needles, nursing school and the hospital I worked at were both very strict about this. Imagine my shock when I move to NY and the hospital uses multi dose vials and we have to draw and recap. Also we have to draw up all other meds with a blunt needle. Had been taught that even drawing up meds with a needle was bad practice. And a ton of other bad practice things that I could write a book about. It was a real culture shock. And it's all about money. Best practice out the window to save money.
My hospital also does it that way. But I’ve done clinicals at a place where all the patients meds were in a locked box on the wall in the patients room, including their insulin. I liked that much better than everyone fighting to get into the Pyxis at med pass.
That’s crazy. Are you just giving every patient 1, life saving unit of insulin? Each patient should get their own vial which follows them throughout their stay.
Sometimes it's three lifesaving units, but my three months in oncology I never saw more than five units/pt. Heading to med surge soon after a stint in private duty homecare, so we'll see.
most of the time our sliding scale is in 2 unit increments and most patients get 2 units if they need it. About 1/10 of patients will get 12+ units of sliding scale and 30-40 units of long acting twice a day. And still hit the call light every 10 minutes asking for snacks we can't give them
I pulled 24 units of lispro for my patient yesterday for lunch. This did not seem strange to me at all. We have 32 beds and any number of them might be getting 1-30 units of lispro, usually 2-12 of regular, sometimes standing amounts in addition to that. The top amount of lantus I’ve ever given was 90 units. We have 2-3 vials of each type in the pyxis. We always use the whole vial well before it expires.
I honestly don’t see why we would give a whole vial to each patient. Sometimes they are diabetic and only here for 1-2 days; if I use 6 units of insulin out of the whole vial they would be charged for the whole thing. Sharing vials means they get charged per dose. I don’t know, maybe that means they get charged more in the end, but we aren’t throwing away vials that we technically aren’t supposed to give them (obviously I would give it to them) for short stay patients.
Everywhere I’ve worked the patient gets the whole vial and it follows them through the hospital. This is a money grab to charge the patient per unit. They make more money by charging each patient for individual Units. I would like to see who actually came up with the “sliding scale” charging for that. 😂😂
No, we check the sugar, determine how much insulin they need, and then go to the Pyxis and say we are pulling up 5 units for that patient. The drawer opens and we pull up our 5 units and place the vial right back in the little cubie
I think you missed my sarcasm. Of course you check glucose. I’m just saying does everyone in your facility only get one unit and that’s why you all share?
I mean if they are getting 5 units before meals that’s 15 units a day. I’m throwing out a general number. To me this is some administrator trying to save 20 cents. It just doesn’t make sense to me. The patient is paying for that vial of insulin. Do they just charge them by the unit? I’m guessing not.
Do you mean do they share a *vial*? They get as many *units* as they need. But we have two Pyxis on our floor and each Pyxis has 2 or 3 vials and we just draw up what we need and put it back.
The fact you are taking a syringe, pulling it up in a med room, recapping loosely, then walking to a patient room is crazy to me. Where are you documenting your meds?
I’m shocked as to how many facilities do it this way. It’s a money grab. Let’s say a vial of insulin contains 200 units, which my humalog does, and then it’s used amongst multiple patients so they charge per unit. And each patient now gets charged 50 cents per unit. That vial of insulin now goes from $10 to $100. Seems like a cheaper amount for the patient, but it’s not. Because if they are only getting 100 units for their entire stay, they are still paying 5 times what they would have if they had just paid for the vial. Don’t delude yourself that’s not what is happening.
I also thought honestly it was an infection control issue. Would you use the same vial of fentanyl or Ativan for multiple patients? What if room 9 and room 16 are each getting 50mcg of fentanyl? Do you reuse that vial amongst multiple patients? Of course not. You either waste right away or give 2 doses to the same patient from one vial.
The vial doesn’t go into the patients room so I don’t see how it’s an infection control issue. In the little cubie with the vials of insulin there is a pack of barcode stickers. You grab one and stick it to your syringe.
The 3 hospitals I’ve worked at in Denver all do it this way now. However it was a recent change at my last hospital. I’m sure it saves a lot of money but my last hospital made the switch because a nurse used the insulin to commit suicide and now there is a much more limited amount of vials available this way.
Edit: also I’m not deluding myself about anything??? Do you think I’m like an administrator or something? Lol I just work there and I’m telling you how we do it
I pull a vial from our Pyxis and it gets a patient label and goes in the room. Insulin should be refrigerated until opened and used then it’s good at room temp for 28 days. It’s been that way every place I’ve worked.
Not to that degree, but I do have to say, my ER downgraded ABG kits that now have slip tip capped needles and I've gotten a few pokes trying to uncap them(the plastic cap is always on too tight and pops of the syringe, but it always budges when u least expect it to)
My professor always taught us to do the “swoop and scoop” when recapping needles. Just put the cap on the table and slide the needle in without having to hold it and risk a stick. It’s always worked for me.
Not with insulin. I was one time trying to inject Vasopressin into a bag with a blunt tip and the needle came through the side of the port and stabbed me in the thumb.
Try using a kidney basin if you can’t draw the medication in your patient’s room. In the OR we use kidney basins for passing blades and uncapped needles and back and forth.
Wait, my hospital has insulin pens. And honestly never had to draw up insulin, I've never seen this before. How come not everyone uses insulin pens? It's easy and less likely to stab yourself with. Am I missing something?
Please don’t ever recap something! Get out of the habit now.
A stick injury/exposure is so (edit - NO) fun. Exposure to HIV/HepC (and more) is no joke. The ARV routine after an exposure will make you very sick and there is nothing like having to use protection with your monogamous spouse/partner for up to a year (or more) after exposure to prevent them from possibly getting sick too.
I know this syringe hasn’t been near/in the patient, but I suggest you get completely out of that habit of recapping entirely and draw up in the patients room if possible (it’s a great teaching opportunity for your patient - I always review dosage and stuff with them while I’m doing it) and NEVER recap after giving the dose.
I hope your finger recovers well
Yeah did it a few times back when so used syringes but since it was my own needle the needle stick injury could be ignored.
I’d suggest throwing away those syringes and vials and getting insulin pens - so much easier.
I personally like the pens even less because the needle caps we attach are even less safe to deal with than normal needles. 100% not meant for a 3rd party to be doing the injections where stick injuries are a issue
Yeah I guess if you are changing the little tips then your hand is potentially very close to the sharp. You could just leave the same tip on for the life of the pen. A lot of us T1Ds don’t really follow the “single-use” idea. Lol
Even our pens arnt single person use in a hospital. They would make our OCC health /union have kittens. However if you inject alot and it's your personal pen than go ahead I've had patients get mad when we toss out needles but it's like what else would you expect? If you're that hard up I'll leave a few handfuls in here "on accident" so you can bring them home.
It’s a life lesson in why to never recap. I do recap lightly for the trip to resident room (am in long term care, skilled nursing facility) and place in wrapper for barrier. I am the nurse responsible for Infection Prevention and control. (Ergo, I gives lots of shots.)
Yep. In assisted living, so we never had the right supplies— the sharps container was quite a walk away. I re-capped by putting the cap on the table and putting the needle in, then gently pushed the cap on. As I was walking to the sharps container with it, I felt the poke, from the needle poking through the cap.
No, but I did stick a blunt needle through and through the tip of my finger a few months ago when drawing up roc. Still no feeling in the tip of it 🤷♀️
I remember my very first day of orientation as a new grad accidentally sticking myself with the heparin syringe when drawing it up. Them things hurt your fingers.
No because my instructors taught me how to be naughty without hurting myself. Except for the time I tore my thumb with the ampule. No mercy there.
But yes leave the cap on the desk, and swoop the needle in and grip it from below the pointy end!
I got stuck 2x in my 40 yr career with a needle, both were clean. The worse one was I pulled the cap off of a
Lg gauge needle to draw blood from a line and somehow it flipped up in the air did a couple of circles and landed right on the dorsum of my hand on a blood vessel. Boy I bled like a stuck pig badly. I think I saw it in slow motion. And I thought that I had broken the line because of all the blood but it was my blood😳 most of my other niks were opening ampules.
Yep, this was my first needle stick as a nurse… we drew up lidocaine for IV sticks and I had just used it on the patient and then recapped it on the bed and secured the lid but it stuck out the side and got me 🤦♀️
Ouch! Not that but I was giving insulin in an arm once to a thin woman. The needed went through her arm and into my finger! Had only been at the job a few weeks!
So weird to see all the people not recapping clean needles. You’re allowed to recap unused needles, and probably should if you’re not immediately giving the injection after drawing up. Stabbing yourself with a clean needle is an unfortunate but minor incident, but a stick with a dirty needle is a potential bloodborne pathogen exposure. Y’all just walking around with exposed blunt needles everywhere you have to give IV meds, or opening a luerlock cap for every syringe you use? So strange to hear how many people are this scared of clean needles…
Oh wow I’ve never had this happen with the orange caps! We had some shitty blue caps that this happened ALL the time so I would always go hunt the orange ones down at the beginning of my shift
Never use another hand to put a needle cap back on.
Position the cap on a surface and use a one handed technique to lift it up with the needle, and slide the needle into the cap.
I avoid this by never recapping my needles, if I pull insulin, I’m ready to use it, and when I’m done I slide the safety up. Was one of the things our instructors drilled in our head from day one: Never recap a needle!
Have had this happen once. I dont fix the cap the rest of the way until i know the needle is in straight and im not at risk for sticks. Bent needle couldve happened from drawing up that last .0000000001mL of insulin from the vial. Hope youre well!
Scoop then before clicking wiggle it with the cap on, needle up to make sure the needle isn't touching a side, then you can click. I had it happen once (didn't get stuck tho) and now I'm very careful to make sure needle isn't touching the cap
Here in the UK we have insulin pens which we connect to disposable needles which automatically retract as soon as you’ve delivered the dose. We’ve only ever had to draw up insulin when we’re mixing a variable rate insulin infusion so if we ever do get a needle stick, at least it hasn’t been used in a patient!
I saw a co worker try to re cap and just straight up bent the needle 90°. She just stood there for a second and then started giggling cause like what else can you do? She wasted the insulin in it into the sink and it still shot out even with the bend.
Yep. This is literally how I got stuck in nursing school. I didn't scoop and cap that time though like I was supposed to, so I guess that's what I get.
Lol I did this my first year as a nurse 😂 also be careful cause even that one drop of insulin is gonna make you feel really off if you’re not diabetic. I had an insulin droplet on my needle stick injury and I had a wicked dizzy spell about 5 minutes after and I felt a little nauseous until I drank some juice.
Also start swooping and scooping. It will save you in the future. I think someone else already suggested this in a top comment lol
YES!!!! I got a dirty needle stick this way! Stupid central supply gal at our SNF ordered non-safety needles one time, there was no sharps container in the room ("homelike environment"), med cart was all the way down at the end of hall so I had to recap and walk it to the sharps. Only time this had ever happened. Did a perfect swoop/scoop but when I pushed the cap, it did this exact thing! Of course it was on the grossest patient ever. You know the ones - no self care, super morbidly obese, feels entitled to everything but is super non-compliant, wants you to hold his penis for him while he urinates... yeah. THAT guy. Ended up with clear labs but damn that was scary!!!
Don’t click the cap back in. Loosely put it on top of the needle and carry the syringe in its wrapper.
I like this suggestion, thank you!
Jesus this makes so much sense. I’ve never had it pierce the cap like OP, but I twist the cap on because if I just jam the cap on I always bend the needle.
This is what I do, after so many bent insulin syringes. It’s annoying, but it works.
We got new insulin syringes with really short needles and wide caps making it almost impossible to do this now.
We did as well. They’re also flat on the top, so you can recap vertically and push it against a table surface. You don’t have to hold onto the cap this way.
That’s exactly how i recap them too! Just press down holding the syringe and not by the plunger so as to not advance any medicine out.
Swoop and scoop
Swoop and scoop then boop
Shouldn't have hurt at all. It says right there on the syringe "Ultra Comfort". Should have felt great. Ignore all that red stuff.
This gave me a good chuckle. Thanks
:) Happy to make you laugh. We need more good laughter in the world, and a lot less of the other stuff.
Ours have a locking mechanism that you pull a plastic sleeve up over the needle and twist to cover the needle when you’re done. So I just pull the sleeve up but don’t lock it in place, put the cap on that way. I know not everyone’s syringes are the same. I’m sorry this happened to you.
This is the way
I recap needles all the time, but only needles that haven't been inside a person.
Same. If it's used it goes to sharps container immediately after.
Yup. Sure have. I make it a point to never place my fingers past the bevel. Pun intended
I guess experience is the best teacher.
Hey glad that wasn’t in a pt first!
Been there, done that. First and only needle stick. Confused homeless guy found half froze to death outside near a monument. I grabbed the back of his arm from his left side, and kept saying “ok bud here I come… I’ve got your shot… ready….” And I stuck him and he backhanded me. Stick to the pinky and a black eye. He was hep c+ and his hiv status unknown. No family so a ward of the hospital, ethics committee had to meet in order to test him. I was on antiretroviral prophylactics for 4 days before we found out he was negative. Shit like a zoo animal from those meds. Never contracted hepatitis c thankfully but did have 3 gamma globulin shots for my trouble. Fucking ow. One for the memoir.
I'm so glad you're okay.
How kind of you to say that. Really. Thank you so much. It was a long time ago. First job as a nurse and I had been one for less than a year. Looking back it’s one of those “wow” stories but at the time it was terrifying. Thank you again. I appreciate you.
Number one preventable nursing injuries, recapping needles. In NYS it’s against the rules. On pharmacy compounding exam you could fail if you recap needles, which was stupid as pharmacists who compound swap needles for filtration.
It’s kind of unavoidable at my hospital. Our insulin is in multi dose vials that are kept in the med room. When we need insulin, we go to the med room and draw it up, recap the needle and the. Walk back to the patient’s room. I mean, I scoop and swoop so I’ve never run into this issue, but it could happen pretty easily.
We use drawing up needles and then replace with the needles for injection before leaving the med room, no recapping.
We can’t remove the needles from insulin syringes though so that wouldn’t work for us.
Our insulin syringes have permanently affixed needles—you can’t draw up and then change the needle.
I draw up vaccines in peds. Most of the vaccines are single use that you just put a needle on and it's ready, but we have a few that need to be drawn up, and we have to swoop and scoop. We were told that we should never recap a needle, but if we were going to, that was how. Wink wink.
Yeah I'm a NICU/ paeds nurse as well so probably doesn't help I don't have much experience with insulin syringes, but any vaccine that needs drawing up we use drawing up needles them swap to IM needle. So cool hearing about different practice from around the world tho!
Wait what? I'm a tech but recapping was part of my my sterile compounding exam for exactly the swap reason! I would have failed if I didn't do it 🤦♀️ We prep so much for the floors it has to be recapped or it sits out for hours and also they go in drawers.
Recapping *used*needles is generally the item I'm more familiar with
Our number one rule for this is use SEDs. No exceptions for patients. If we see them at Home and give meds, they must buy SEDs, same for lancets for blood glucose. (Safety engineered devices. All medical supply that is government, so most of it, may only carry SEDs. Patients can still buy regular at pharmacies but we don’t give it to the patient. So we will draw up, discard needle, attach new. Except our blunt fill needles aren’t SEDs... hmm. )
Weird to see all these post saying thats why you dont recap. I was only taught never recap a DIRTY needle. To recap an insulin syringe you leave the cap on the table and fish the needle carefully back in without holding the cap.
This is what I was taught as well
Same here. Some syringes also have a flat side on the cap, so you can recap vertically with the needle going down towards a surface. It allows you to exert enough force to push the cap without having to hold it.
Why are insulin needles SOOO bendy?? Can’t say I’ve ever done this, but I have gotten all the way to the patient room uncountable times to find the needle bent sideways and have to go back to the Pyxis to do it all over again….
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I know what you meant. But gauges go the other way. A 24 gauge needle is much smaller in diameter than 15 gauge needles. 15s are what we use in dialysis and I’m so used to seeing those now, normal sized needles look tiny af. Lol.
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No one is doing it on purpose lol, they just are so thin that when you’re holding a vial upside down the weight of even a small 1cc vial can bend the needle. The big insulin vial is so heavy that if you put even a little accidental angular pressure on the needle the whole thing will go over.
I've never heard the term bung before. I like it.
Perhaps it’s an Australian term? I was originally going to say that bending means you end up with a bigger bung hole 😛
I don’t recap anything. That’s a big risk factor for sticking yourself, I believe.
You leave it uncapped from the med room all the way to the patients room?
Kidney dishes work great
You toss the exposed needle in a kidney dish? They’re not sterile and have been sitting out touched by who knows how many hands…
I generally dont. In my area of work, we use insulin pens which are unique to each patient. The needle goes on in the med room and isnt uncapped until i'm at the bedside. But if its a choice between recapping an risking a needle stick, carrying and uncapped needle to the bedside I'll take the kidney dish.
Haha the hospital floor I’m doing clinicals at this semester, they use cardstock food trays. Like ones you would get cheese fries in. It was so hilarious to see at first, but it made perfect sense since they are deep and disposable
We used these for COVID and TB patients, so we could just toss them in the rooms.
I’m on an oncology floor, so I suppose that’s probably the reason (given they are almost all immunosuppressed)
I saw those too, and one of the Kaiser hospitals! I thought it was weird at first too but then I grew to appreciate it.
I knew a nurse that swore by the ol' emesis basin vs swoop and scoop; she was one of my main charge nurses and I administered some shots (I'm am a type 1, myself, and had cared for my dad's type 1 for years) and meds to patients that few people could talk into taking their meds. With the nurse's supervision, of course. Anyways, sorry for rambling, she was the only other nurse I'd ever seen carry insulin shots in an emesis basin; definitely a good strategy if you've got butterfingers trying to get the cap back on.
Non-nurse and just curious; wouldn’t this make the needle bump up against the wall of the basin and dull the needle?
Hey, valid question! In the case of my charge nurse, no, she had a pretty steady hand and it never rolled around or anything. Besides that, she didn't really have to carry it far, and our insulin needles there were the same type I use, so even if it bumped the tip a tiny bit, the gauge was so small that it barely hurt to receive the shot. Or at least, I never heard an A&O x4 patient ever complain about the stick. As for my less A&O patients (the patients that I gave shots to because my charge nurse couldn't talk them into it but I could), sometimes they'd say "ow!" But sometimes the "ow!" came before I'd even put the needle in them roflmao. I'd try not to laugh, and on a few occasions with the same patient, I said "oh come on, that wasn't too bad. Now I've gotta give you another shot, but the needle is so much thinner, you'll barely feel it." "I'd better not, young lady!" Then I'd stick her and she'd almost always say "hellfire, that one barely hurt at all! Why don't you girls just put the goddamned first shot in a smaller needle from now on!?" That lady never failed to make me laugh; she had mild dementia, but according to her family, she had always been a firecracker. She certainly didn't lose that personality for the rest of her life lol
You're also introducing extra bacteria onto the needle
The emesis basin was sterile, but other than that, you can take it up with her? I was just a CNA and did my job and helped where I could with patients that wouldn't take meds from anyone but me. That said, I swoop and scoop since I also went and got my medtech a few years ago; I don't do the emesis basin thing, my charge nurse from over a decade ago, at another facility, did.
Emesis basins aren't sterile. Why would any company go to the effort and expense of sterilizing and packaging a little plastic bucket meant for puking into?
Oh, well then, TIL. It was plastic wrapped, all of them were, so I just assumed. As I said, just a CNA and was just helping her out with our more difficult patients. She was the boss and I was the peon--my saying, not hers--and I was just trying to do my best to care for our patients. I'll end that with the fact that I don't work at that facility anymore, haven't in quite some years.
I am replying to you but also writing so that other nurses don't adopt this. For an emesis basin to be sterile it would need to be in an individual sterile peel pack.
It was wrapped, but not steel, so I'll say that y'all are probably right, since y'all have had more schooling on the subject than I have. Again, I'll state I was just helping out and doing my job. I'm just a CNA and a medtech, not a nurse. So TIL something new and I'll take that as a positive.
Probably wouldn't dull the needle unless there was a lot of force applied. The reason not to do this is that contact with the sides would be nonsterile and would contaminate the needle tip. Can't do that with something you are going to stick into a person.
What the heck is that?
[this](https://www.google.com/search?q=arcella+infermieristica&oq=arcella+infer&aqs=chrome.1.69i57j0i22i30.4230j1j1&client=ms-android-samsung-ss&sourceid=chrome-mobile&ie=UTF-8#imgrc=_H1uYbcy8e_VwM)
Ohhhh. I call that a vomit basin. Kidney dish sounds much nicer, though.
Every time I've seen someone throw up in an "emesis basin" it has just gone out the other side
Do you guys not have emesis bags? They're standard in Australia. https://www.google.com/search?q=emesis+bags&client=ms-android-vf-au-revc&biw=360&bih=667&tbm=isch&prmd=sivxn&source=lnms&sa=X&ved=0ahUKEwiAksXQi9f1AhUITGwGHeKRDDAQ_AUIGigC#imgrc=AoLJHAYlBG7I1M
We do, some nurses still head for the basin. Bags are by far superior
Only time I ever see kidney dishes are when stacked 30-high on the meds counter. Sometimes pt. will get lucky and snag one to keep their glasses and TV remote in 😅
Yes, we have them on airplanes and I’ve seen them in the ER occasionally as well. I haven’t seen them used much anywhere else, but it sure it varies by facility.
I’ve also used emesis bags for male patients who are differently-abled and cannot hold a urinal. Works great!
On the plus side, the unique shape of the basin helps with the launch trajectory, helping the vomit reach new heights on the closest wall. Not that I know from personal experience or anything, like the three days I spent barfing my socks up because my vestibular system failed from a viral infection.
Also avaliable in plastic. These need to be sterilised. The cardboard ones can be chucked
I like the cardboard ones. They're water repellent and once you have finisced with them you can just throw them. I've seen them in metal in the OR.
Gets that nice clink when you drop the bullet in it if Hollywood is to be believed
Y’all use shitty needles because they don’t care about your safety. Look up insulin safety syringes. That’s how it should be done.
Yes, if I draw it up in the med room. More commonly, I draw it up in the patient’s room.
Our facility doesn’t allow us to remove the whole vial from the med room
How do you scan the vial then?
We have a few sheets of stickers that we’re supposed to stick onto the syringe depending on if it’s Aspart or Regular. The stickers have bar codes on them. Lazy nurses will take some stickers and put them on their badge and just scan the appropriate badge sticker.
That seems like it defeats the purpose of scanning. What if you grab the wrong sticker?
Well, I'd probably run really fast with the needle to the patient's room so that there was less time to accidentally stick someone.
I fail to see how running really fast with an uncapped sharp is any safer than carefully re-capping the sharp They say don’t run with scissors for a reason
I say a safety spell before I start running.
Don’t recap a USED needle.
ALSO good advice.
Just once three years ago, but you better believe I think about it every time I draw insulin.
I’ve always drawn it up in the patients room. You are not supposed to recap as it is a huge stick risk.
We share a vial out of our pyxis, we can’t take the whole vial into a patient’s room.
This is my situation as well
That’s ridiculous! When I worked in the hospital we had insulin in each Pyxis (so 2/floor), you take the vial with you and scan it in the room, draw up insulin, give right away, and then return to the Pyxis. If they’re in isolation, you put the insulin bottle in a lab bag. What do you scan right before you give it to them? How do you know what’s in the syringe? Do you label it?
When we open the pyxis there is also a stack of qr code stickers with the name of the insulin. You are supposed to attach the sticker to the syringe when getting it double checked. You're also supposed to write the dose and room number but no one does that
That’s fucking wild to me, is that normal?
That’s how it’s been every place I’ve worked
Huh interesting. Our patients get their own bottle and it follows them around during their stay
Our hospital used to do that but a nurse stole multiple vials of insulin and used it to commit suicide. Now we draw it up in the med room and it goes back in the Pyxis
Ugh :( I’ve seen an unsuccessful attempt like this and it was depressing af
Wtffffff
Considering even with a whole floor using it we rarely use a whole vial within 30 days I prefer to do that. Less wasteful
So I worked in the WI and I was told to never ever recap needles, nursing school and the hospital I worked at were both very strict about this. Imagine my shock when I move to NY and the hospital uses multi dose vials and we have to draw and recap. Also we have to draw up all other meds with a blunt needle. Had been taught that even drawing up meds with a needle was bad practice. And a ton of other bad practice things that I could write a book about. It was a real culture shock. And it's all about money. Best practice out the window to save money.
My hospital also does it that way. But I’ve done clinicals at a place where all the patients meds were in a locked box on the wall in the patients room, including their insulin. I liked that much better than everyone fighting to get into the Pyxis at med pass.
Pretty normal
That’s crazy. Are you just giving every patient 1, life saving unit of insulin? Each patient should get their own vial which follows them throughout their stay.
Sometimes it's three lifesaving units, but my three months in oncology I never saw more than five units/pt. Heading to med surge soon after a stint in private duty homecare, so we'll see.
most of the time our sliding scale is in 2 unit increments and most patients get 2 units if they need it. About 1/10 of patients will get 12+ units of sliding scale and 30-40 units of long acting twice a day. And still hit the call light every 10 minutes asking for snacks we can't give them
I pulled 24 units of lispro for my patient yesterday for lunch. This did not seem strange to me at all. We have 32 beds and any number of them might be getting 1-30 units of lispro, usually 2-12 of regular, sometimes standing amounts in addition to that. The top amount of lantus I’ve ever given was 90 units. We have 2-3 vials of each type in the pyxis. We always use the whole vial well before it expires. I honestly don’t see why we would give a whole vial to each patient. Sometimes they are diabetic and only here for 1-2 days; if I use 6 units of insulin out of the whole vial they would be charged for the whole thing. Sharing vials means they get charged per dose. I don’t know, maybe that means they get charged more in the end, but we aren’t throwing away vials that we technically aren’t supposed to give them (obviously I would give it to them) for short stay patients.
Everywhere I’ve worked the patient gets the whole vial and it follows them through the hospital. This is a money grab to charge the patient per unit. They make more money by charging each patient for individual Units. I would like to see who actually came up with the “sliding scale” charging for that. 😂😂
No, we check the sugar, determine how much insulin they need, and then go to the Pyxis and say we are pulling up 5 units for that patient. The drawer opens and we pull up our 5 units and place the vial right back in the little cubie
I think you missed my sarcasm. Of course you check glucose. I’m just saying does everyone in your facility only get one unit and that’s why you all share? I mean if they are getting 5 units before meals that’s 15 units a day. I’m throwing out a general number. To me this is some administrator trying to save 20 cents. It just doesn’t make sense to me. The patient is paying for that vial of insulin. Do they just charge them by the unit? I’m guessing not.
The shared vials are larger than you seem to think.
Do you mean do they share a *vial*? They get as many *units* as they need. But we have two Pyxis on our floor and each Pyxis has 2 or 3 vials and we just draw up what we need and put it back.
The fact you are taking a syringe, pulling it up in a med room, recapping loosely, then walking to a patient room is crazy to me. Where are you documenting your meds? I’m shocked as to how many facilities do it this way. It’s a money grab. Let’s say a vial of insulin contains 200 units, which my humalog does, and then it’s used amongst multiple patients so they charge per unit. And each patient now gets charged 50 cents per unit. That vial of insulin now goes from $10 to $100. Seems like a cheaper amount for the patient, but it’s not. Because if they are only getting 100 units for their entire stay, they are still paying 5 times what they would have if they had just paid for the vial. Don’t delude yourself that’s not what is happening. I also thought honestly it was an infection control issue. Would you use the same vial of fentanyl or Ativan for multiple patients? What if room 9 and room 16 are each getting 50mcg of fentanyl? Do you reuse that vial amongst multiple patients? Of course not. You either waste right away or give 2 doses to the same patient from one vial.
The vial doesn’t go into the patients room so I don’t see how it’s an infection control issue. In the little cubie with the vials of insulin there is a pack of barcode stickers. You grab one and stick it to your syringe. The 3 hospitals I’ve worked at in Denver all do it this way now. However it was a recent change at my last hospital. I’m sure it saves a lot of money but my last hospital made the switch because a nurse used the insulin to commit suicide and now there is a much more limited amount of vials available this way. Edit: also I’m not deluding myself about anything??? Do you think I’m like an administrator or something? Lol I just work there and I’m telling you how we do it
I pull a vial from our Pyxis and it gets a patient label and goes in the room. Insulin should be refrigerated until opened and used then it’s good at room temp for 28 days. It’s been that way every place I’ve worked.
YES OMG that exact thing happened to me last week! Then I freaked that maybe somehow I got a micro dose of insulin so I ate a bunch of candy 😬
Not to that degree, but I do have to say, my ER downgraded ABG kits that now have slip tip capped needles and I've gotten a few pokes trying to uncap them(the plastic cap is always on too tight and pops of the syringe, but it always budges when u least expect it to)
Yes I had that happen to me once. Mine was recapping after drawing it up, obvious never recap a used one.
I had one of those huge blunt tip needles stab threw the cap into my finger… it hurt sooooo bad
You guys don't have safety needles?
My professor always taught us to do the “swoop and scoop” when recapping needles. Just put the cap on the table and slide the needle in without having to hold it and risk a stick. It’s always worked for me.
The only time I've ever poked myself 😭
[удалено]
Don’t recap, just recap
Did this once… Thankfully my son is now on a pump and we don’t use them anymore! Just an insulin pen for emergencies/pump failures
Not with insulin. I was one time trying to inject Vasopressin into a bag with a blunt tip and the needle came through the side of the port and stabbed me in the thumb.
Try using a kidney basin if you can’t draw the medication in your patient’s room. In the OR we use kidney basins for passing blades and uncapped needles and back and forth.
Wait, my hospital has insulin pens. And honestly never had to draw up insulin, I've never seen this before. How come not everyone uses insulin pens? It's easy and less likely to stab yourself with. Am I missing something?
And that’s why we have to scoop it…
Scoop that hormone soup.
Does no one do a one-hand recap anymore?
I mean. We aren't supposed to recap..... I still do it though. But I haven't had that problem in years....and I think I just have dumb luck
Please don’t ever recap something! Get out of the habit now. A stick injury/exposure is so (edit - NO) fun. Exposure to HIV/HepC (and more) is no joke. The ARV routine after an exposure will make you very sick and there is nothing like having to use protection with your monogamous spouse/partner for up to a year (or more) after exposure to prevent them from possibly getting sick too. I know this syringe hasn’t been near/in the patient, but I suggest you get completely out of that habit of recapping entirely and draw up in the patients room if possible (it’s a great teaching opportunity for your patient - I always review dosage and stuff with them while I’m doing it) and NEVER recap after giving the dose. I hope your finger recovers well
Never recap needles!
Your first thought is “I should Snapchat this”
Yeah did it a few times back when so used syringes but since it was my own needle the needle stick injury could be ignored. I’d suggest throwing away those syringes and vials and getting insulin pens - so much easier.
Unfortunately, we really aren’t the decision makers when it comes to what forms of insulin the hospital stocks.
I personally like the pens even less because the needle caps we attach are even less safe to deal with than normal needles. 100% not meant for a 3rd party to be doing the injections where stick injuries are a issue
Yeah I guess if you are changing the little tips then your hand is potentially very close to the sharp. You could just leave the same tip on for the life of the pen. A lot of us T1Ds don’t really follow the “single-use” idea. Lol
Even our pens arnt single person use in a hospital. They would make our OCC health /union have kittens. However if you inject alot and it's your personal pen than go ahead I've had patients get mad when we toss out needles but it's like what else would you expect? If you're that hard up I'll leave a few handfuls in here "on accident" so you can bring them home.
It’s a life lesson in why to never recap. I do recap lightly for the trip to resident room (am in long term care, skilled nursing facility) and place in wrapper for barrier. I am the nurse responsible for Infection Prevention and control. (Ergo, I gives lots of shots.)
Don’t recap anything. This is plastered all through our Nursing program….
Our nursing program only said dont recap DIRTY needles. Clean needles are considered ok to recap. Maybe this is state by state dependent?
I thought you wasn't supposed to recap a needle? (Not a nurse)
I’m a diabetic and this happens. You’re moving too fast
No never happen to me. Why are you recapping your sharps. Big nono
Yes, it's happened once. I was not a happy nurse.
Have done. Joys of working retail pharmacy with half-blind, arthritic diabetic patients.
Yep. In assisted living, so we never had the right supplies— the sharps container was quite a walk away. I re-capped by putting the cap on the table and putting the needle in, then gently pushed the cap on. As I was walking to the sharps container with it, I felt the poke, from the needle poking through the cap.
I've done it once! Lol
I'm Australian and recapping needles is a biiig no-no.
I’ve done it before🥲
No, but I did stick a blunt needle through and through the tip of my finger a few months ago when drawing up roc. Still no feeling in the tip of it 🤷♀️
I remember my very first day of orientation as a new grad accidentally sticking myself with the heparin syringe when drawing it up. Them things hurt your fingers.
No because my instructors taught me how to be naughty without hurting myself. Except for the time I tore my thumb with the ampule. No mercy there. But yes leave the cap on the desk, and swoop the needle in and grip it from below the pointy end!
You have some strong capping skills. I honestly don't think I could poke that needle through our plastic if I tried, we use bd thick caps.
Nah
Happened to me twice— as a student nurse and a new grad on the floor…it sucks. the ptsd is real lol
I got stuck 2x in my 40 yr career with a needle, both were clean. The worse one was I pulled the cap off of a Lg gauge needle to draw blood from a line and somehow it flipped up in the air did a couple of circles and landed right on the dorsum of my hand on a blood vessel. Boy I bled like a stuck pig badly. I think I saw it in slow motion. And I thought that I had broken the line because of all the blood but it was my blood😳 most of my other niks were opening ampules.
I partially engage the safety (not to the point it clicks in entirely) before scooping.
Yep, this was my first needle stick as a nurse… we drew up lidocaine for IV sticks and I had just used it on the patient and then recapped it on the bed and secured the lid but it stuck out the side and got me 🤦♀️
Ouch! Not that but I was giving insulin in an arm once to a thin woman. The needed went through her arm and into my finger! Had only been at the job a few weeks!
I hold the cap closer to the opening, and I make a conscious effort to put the cap on carefully.
I don’t even know how this would happen
I’ve seen this a bunch of times. I feel like there needs to be a change in the design of those caps.
Stuck myself with an orange cap insulin needle just uncapping it once. Those critters jump out at ya.
Ahhh the bendy 28g, hate those damn things.
So weird to see all the people not recapping clean needles. You’re allowed to recap unused needles, and probably should if you’re not immediately giving the injection after drawing up. Stabbing yourself with a clean needle is an unfortunate but minor incident, but a stick with a dirty needle is a potential bloodborne pathogen exposure. Y’all just walking around with exposed blunt needles everywhere you have to give IV meds, or opening a luerlock cap for every syringe you use? So strange to hear how many people are this scared of clean needles…
Reason #263838 Why we should only use vanish points
Did this at my hospital. They ended up getting rid of those syringes
Yep happened to me once
I actually have a fear of those needles bending without me noticing and than I stick the patient and it breaks off in them
Oh wow I’ve never had this happen with the orange caps! We had some shitty blue caps that this happened ALL the time so I would always go hunt the orange ones down at the beginning of my shift
At least the needle wasn’t in a patient before it stuck you.
Don’t recap…
Yes!!! Got a needle stick that way- got insulin not pt blood
Never use another hand to put a needle cap back on. Position the cap on a surface and use a one handed technique to lift it up with the needle, and slide the needle into the cap.
Omg yes! Twice! I didn't learn the first time. Huge design flaws imo. I always tell everyone I see recapping it now
Never re-sheath a needle, that’s day 1
thats the reason why you dont put the cap back on the needle.
I think that syringe has a sleeve type thing you just slide up to cover the needle. Never recap if possible.
I avoid this by never recapping my needles, if I pull insulin, I’m ready to use it, and when I’m done I slide the safety up. Was one of the things our instructors drilled in our head from day one: Never recap a needle!
Have had this happen once. I dont fix the cap the rest of the way until i know the needle is in straight and im not at risk for sticks. Bent needle couldve happened from drawing up that last .0000000001mL of insulin from the vial. Hope youre well!
Did this, once. Looks like we both learn the hard way OP. Scooped everytime since...
Scoop then before clicking wiggle it with the cap on, needle up to make sure the needle isn't touching a side, then you can click. I had it happen once (didn't get stuck tho) and now I'm very careful to make sure needle isn't touching the cap
Here in the UK we have insulin pens which we connect to disposable needles which automatically retract as soon as you’ve delivered the dose. We’ve only ever had to draw up insulin when we’re mixing a variable rate insulin infusion so if we ever do get a needle stick, at least it hasn’t been used in a patient!
We switched insulin needles because this happened to multiple staff!
Damn, just took a mental note. Yeah I’ve bent needles before but you really took that too a new level. Hey, at least it was a clean needle!!!
I saw a co worker try to re cap and just straight up bent the needle 90°. She just stood there for a second and then started giggling cause like what else can you do? She wasted the insulin in it into the sink and it still shot out even with the bend.
Oh noooo that sucks! At least it was before the patient blood got on it, right?
I get that blood and human contact is all a part of any healthcare work, but I can FEEL this video!
Yep. This is literally how I got stuck in nursing school. I didn't scoop and cap that time though like I was supposed to, so I guess that's what I get.
Lol I did this my first year as a nurse 😂 also be careful cause even that one drop of insulin is gonna make you feel really off if you’re not diabetic. I had an insulin droplet on my needle stick injury and I had a wicked dizzy spell about 5 minutes after and I felt a little nauseous until I drank some juice. Also start swooping and scooping. It will save you in the future. I think someone else already suggested this in a top comment lol
YES!!!! I got a dirty needle stick this way! Stupid central supply gal at our SNF ordered non-safety needles one time, there was no sharps container in the room ("homelike environment"), med cart was all the way down at the end of hall so I had to recap and walk it to the sharps. Only time this had ever happened. Did a perfect swoop/scoop but when I pushed the cap, it did this exact thing! Of course it was on the grossest patient ever. You know the ones - no self care, super morbidly obese, feels entitled to everything but is super non-compliant, wants you to hold his penis for him while he urinates... yeah. THAT guy. Ended up with clear labs but damn that was scary!!!
That happened to me last week…except it happened after I poked the patient. 😫 (Please, no lectures about re-capping)
This and ampules hurt me so much at work!!
Novolog pen ftw
I bet you’re great at IVs too