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Trish
SFN Addict

USA
2102 Posts

Posted - 10/27/2005 :  19:37:44  Show Profile Send Trish a Private Message
http://www.nurseweek.com/news/99-5/5d.html

quote:
A colleague reported seeing Elaine Giorgi, a lab technician at the SmithKline Beecham lab in Palo Alto, reuse a needle on March 22. During the investigation that followed, Giorgi admitted repeatedly reusing needles—after washing them with hydrogen peroxide—to draw blood from patients whose veins were hard to access. More than 3,600 patients who received blood tests during the phlebotomist's nearly five years at the lab were advised to undergo blood tests for AIDS and hepatitis.


Oh my! While this is hopefully not common in my chosen profession, there are a few things that you can look for to prevent getting caught in this situation: When the phlebotomist lays out the needle, the little paper tape on the colored cap should not be broken, if it is, insist on a new needle. A butterfly needle should still be in its sterile wrapper until the phlebotomist is ready to use it.

Just the thought that someone who has undergone training for bloodborne pathogens has such diregard for the safety of the patient, not to mention their own!, boggles the mind. Additionally, there is some concern that this individual may have damaged test results for studies conducted by a university.

http://www.aegis.com/news/ap/1999/AP990316.html (another scary situation)

quote:
The risk of spreading HIV or hepatitis is much higher with a hollow-core needle that draws blood, Feltmann said.


Anyway, just keep your eyes open when seeking medical care. If something seems fishy, ask. If you don't trust the phlebotomist they send, ask for another one. If you get stuck more than twice (that's usually what most places give for average tries) ask for another phlebotomist. If you don't see the stuff prepackaged, insist on new!

...no one has ever found a 4.5 billion year old stone artifact (at the right geological stratum) with the words "Made by God."
No Sense of Obligation by Matt Young

"Say what you will about the sweet miracle of unquestioning faith. I consider the capacity for it terrifying and vile!"
Mother Night by Kurt Vonnegut, Jr.

They (Women Marines) don't have a nickname, and they don't need one. They get their basic training in a Marine atmosphere, at a Marine Post. They inherit the traditions of the Marines. They are Marines.
LtGen Thomas Holcomb, USMC
Commandant of the Marine Corps, 1943

ronnywhite
SFN Regular

501 Posts

Posted - 10/27/2005 :  21:26:12   [Permalink]  Show Profile Send ronnywhite a Private Message
quote:
Originally posted by Trish
... If you don't see the stuff prepackaged, insist on new!



Makes sense, but unfortunately, for the most part we have to take it for granted that these people exercise some degree of professionalism... I'm sure some don't, and I've personally wondered more than once. I've read that peroxide isn't even a very good disinfectant/antiseptic, either, although it "bubbles out" cuts pretty well. Disgusting ignorance and negligence.

Ron White
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Siberia
SFN Addict

Brazil
2322 Posts

Posted - 10/28/2005 :  06:16:15   [Permalink]  Show Profile  Visit Siberia's Homepage  Send Siberia an AOL message  Send Siberia a Yahoo! Message Send Siberia a Private Message
Here, most labs have a policy where the phlebo-whatever has to unwrap and discard the needle before the patient. Usually I draw on the car, so I don't get to see it destroyed, but I do see said phlebo-whatever unwrap it.

"Why are you afraid of something you're not even sure exists?"
- The Kovenant, Via Negativa

"People who don't like their beliefs being laughed at shouldn't have such funny beliefs."
-- unknown
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Rubicon95
Skeptic Friend

220 Posts

Posted - 10/28/2005 :  09:47:48   [Permalink]  Show Profile Send Rubicon95 a Private Message
That's disturbing. Hopefully it is only an isolated incident. Thanks for the information, I go in 4 times a year to get stuck. Just to see if my blood has become butter yet, or if my liver is failing from the statin drugs.

Didn't that phleb have to sign the vial or order when she did the draw? Is that standard? or is it dependent on the Lab/Hospital?

"People talking at movie shows
People smoking in bed
People voting Republican
Give them Boot to the Head" The Frantics
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BigPapaSmurf
SFN Die Hard

3192 Posts

Posted - 10/28/2005 :  10:33:02   [Permalink]  Show Profile Send BigPapaSmurf a Private Message
Also related, up to 1000 Exxon employees were given fake flu shots by contracted doc.

"...things I have neither seen nor experienced nor heard tell of from anybody else; things, what is more, that do not in fact exist and could not ever exist at all. So my readers must not believe a word I say." -Lucian on his book True History

"...They accept such things on faith alone, without any evidence. So if a fraudulent and cunning person who knows how to take advantage of a situation comes among them, he can make himself rich in a short time." -Lucian critical of early Christians c.166 AD From his book, De Morte Peregrini
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Trish
SFN Addict

USA
2102 Posts

Posted - 10/28/2005 :  19:37:07   [Permalink]  Show Profile Send Trish a Private Message
Rubicon, the phleb does have to initial each tube of blood drawn, that's CLIA '88 standard or NCCLS, one. But the likelihood of the labs keeping the tubes of blood for the length of time to go very far back is unlikely. So unless the lab keeps records of who drew who...there wouldn't be any record kept of that particular information. Phlebs in the patient care clinics don't sign any specific record for drawing a patient like they would in a hospital setting. And that information is so a patient isn't drawn twice in the hospital, but I'm not certain how long that information is kept, and won't know until sometime after I get a job in a hospital.

...no one has ever found a 4.5 billion year old stone artifact (at the right geological stratum) with the words "Made by God."
No Sense of Obligation by Matt Young

"Say what you will about the sweet miracle of unquestioning faith. I consider the capacity for it terrifying and vile!"
Mother Night by Kurt Vonnegut, Jr.

They (Women Marines) don't have a nickname, and they don't need one. They get their basic training in a Marine atmosphere, at a Marine Post. They inherit the traditions of the Marines. They are Marines.
LtGen Thomas Holcomb, USMC
Commandant of the Marine Corps, 1943
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ronnywhite
SFN Regular

501 Posts

Posted - 10/28/2005 :  20:24:55   [Permalink]  Show Profile Send ronnywhite a Private Message
quote:
Originally posted by BigPapaSmurf

Also related, up to 1000 Exxon employees were given fake flu shots by contracted doc.



Wow, I wonder how they found out! They must have pulled the doc's license for that (it takes a pretty big screw-up to pull one of their licenses... they don't do it very much.)

Ron White
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Rubicon95
Skeptic Friend

220 Posts

Posted - 10/31/2005 :  11:19:44   [Permalink]  Show Profile Send Rubicon95 a Private Message
Trish, Thanks for the information. My job deals with hospitals and barcoding. I'm on the tech end of things not on the process. In areas of Phlebotomy, we have devices that can require user id on blood draws. I didn't know if it was a Fed requirement or not, and if it did I'm sure HIPAA has some requirements. I was curious. Once again thanks - light dawns on Marblehead.

"People talking at movie shows
People smoking in bed
People voting Republican
Give them Boot to the Head" The Frantics
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beskeptigal
SFN Die Hard

USA
3834 Posts

Posted - 11/01/2005 :  00:50:04   [Permalink]  Show Profile Send beskeptigal a Private Message
The fake flu shots were discovered by a suspicious nurse hired to give the shots. She knew all the vials shouldn't have been opened but they were so she reported it to someone, I'm not sure who.

Someone using needles over again is pretty rare. There is very little reason to since they aren't that expensive. Butterfly needles do cost about $1/each in my practice but the other phlebotomy needles are free from the lab I send the blood to. I'm not sure what was going on in the above story.

I don't think one has to be overly worried about such events. There are plenty of much more common hazards out there to worry about. Re-using needles isn't high on the list unless you're in a third world country.

Fake drugs seems to be an increasing scam. I always point out the flu shots at the mall and the local Safeway are not the safest even when the drugs are not fakes. They are often administered by nurses moonlighting that have no emergency skills and no epinephrine should an allergic reaction occur. The best places are at the pharmacies since the pharmacists give the shots or at the regular clinics like those at senior centers. They often have home health agencies giving the shots. At least they are given by regularly employed nurses rather than ones hired just to give shots each year.
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Trish
SFN Addict

USA
2102 Posts

Posted - 11/01/2005 :  20:21:41   [Permalink]  Show Profile Send Trish a Private Message
quote:
Someone using needles over again is pretty rare. There is very little reason to since they aren't that expensive. Butterfly needles do cost about $1/each in my practice but the other phlebotomy needles are free from the lab I send the blood to. I'm not sure what was going on in the above story.


See, that's what I don't get. Why was she reusing the needles? If you read her statement, she was doing so for hard to access veins. Once the needle is out, that's it, you toss it in the sharps and get a new one. Again, if it's appropriate, you use a butterfly. I've couldn't conceive of using a needle twice for any reason. There doesn't seem to be a real concern for the number of needles tossed, damaged needles go into the sharps without ever being used on a patient, as do ones that may have had caps twisted breaking the seal without actually exposing the needle. Now attempts to reuse tubes have never made any sense, though I've seen that. Once the vacuum seal is broken, you aren't going to get any blood into the tube. So once the tube has been seated, you might as well toss it.

I avoid shots like the plague. Hey, I know alot of people, paramedics and nurses that moonlight at those health fair/benefits things. It's a good way to pick up an extra $100. Many of the nurses don't like not having the availability of something for a reaction but the extra funds are necessary for some of them. Most of the people who work these fairs are regularly employed, this is just a bit extra for most of them.

I don't know which is more frightening, that or Kaiser doing the drive-through flu shots if you are concerned about reactions to the shots themselves.

...no one has ever found a 4.5 billion year old stone artifact (at the right geological stratum) with the words "Made by God."
No Sense of Obligation by Matt Young

"Say what you will about the sweet miracle of unquestioning faith. I consider the capacity for it terrifying and vile!"
Mother Night by Kurt Vonnegut, Jr.

They (Women Marines) don't have a nickname, and they don't need one. They get their basic training in a Marine atmosphere, at a Marine Post. They inherit the traditions of the Marines. They are Marines.
LtGen Thomas Holcomb, USMC
Commandant of the Marine Corps, 1943
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beskeptigal
SFN Die Hard

USA
3834 Posts

Posted - 11/02/2005 :  03:30:21   [Permalink]  Show Profile Send beskeptigal a Private Message
I didn't mean to imply that any nurse moonlighting wasn't qualified to give flu shots. I just meant there are many who do so that have very little if any training in what they are doing. In essence a nurse on their own giving flu shots is acting as the prescriber since they make the decision on who to give the shots too. My first public health job I had a boss who made a point of that fact. It's easy to give shots but the first time something happens you find out in a hurry what it means to be on your own. These guys are typically alone at a mall or other location. There isn't anyone to ask questions of or call except 911. Then it depends on response time. In Seattle, response time to a 911 call is merely minutes. But in many more rural areas and small towns it can be 10 or more minutes. That's plenty of time for someone to die if you don't have the skills and drugs to respond yourself.

I know what the guidelines and national standards are for vaccinations. I can tell you from experience many doctors are poorly informed as to the vaccine standards. I have to correct bad information people have gotten from nurses and doctors all the time. It is really sad considering there are published guidelines from the ACIP, Advisory Committee on Immunization Practices. There are VISs, Vaccine Information Statements, required by law to be given with vaccines. Yet I have seen many a mall flu shot given by nurses and companies that have never even heard of VISs. If you don't see a VIS you know the person giving the shots is poorly informed.
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Trish
SFN Addict

USA
2102 Posts

Posted - 11/02/2005 :  08:07:29   [Permalink]  Show Profile Send Trish a Private Message
Oh, those sheets that I was given by the Health Department when I went to get my twinrix? About potential problems/misconceptions with regard to vaccines. Yeah, they've the entire range of them at the Health Department. Um, there're only nurses on duty there also. Much has devolved onto the nursing profession in the attempt to keep costs low. Being alone with out back up medical support is the one major concern among most of the nurses I've met that work them. They do keep their cell phones handy, and there are plenty of ERSs in this area.

...no one has ever found a 4.5 billion year old stone artifact (at the right geological stratum) with the words "Made by God."
No Sense of Obligation by Matt Young

"Say what you will about the sweet miracle of unquestioning faith. I consider the capacity for it terrifying and vile!"
Mother Night by Kurt Vonnegut, Jr.

They (Women Marines) don't have a nickname, and they don't need one. They get their basic training in a Marine atmosphere, at a Marine Post. They inherit the traditions of the Marines. They are Marines.
LtGen Thomas Holcomb, USMC
Commandant of the Marine Corps, 1943
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beskeptigal
SFN Die Hard

USA
3834 Posts

Posted - 11/02/2005 :  12:43:44   [Permalink]  Show Profile Send beskeptigal a Private Message
I'm a nurse practitioner but even when I was a nurse I did many highly skilled and technical jobs. You wouldn't want most doctors taking care of you in ICU for instance. The health departments specialize in vaccinations. I'd never hesitate to get vaccinated at the health department. And for whatever reason, vaccinations and preventative infectious disease medicine is a nursing specialty more than a doctor specialty. Only public health doctors and pediatricians know vaccines very well. But nurses have to be experienced in the field and not all nurses are. I know some nurses that moonlight giving flu shots and the companies that hire them are practically fly by nights.
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Trish
SFN Addict

USA
2102 Posts

Posted - 11/04/2005 :  21:11:48   [Permalink]  Show Profile Send Trish a Private Message
Well, I'll take a corpsman or medic most any day over most of the medical profession. But then again, their training is excellent. Doctors and nurses in the military are a mixed bag, some really outstanding ones and whole lot of that need remedial education with regard to medicine.

...no one has ever found a 4.5 billion year old stone artifact (at the right geological stratum) with the words "Made by God."
No Sense of Obligation by Matt Young

"Say what you will about the sweet miracle of unquestioning faith. I consider the capacity for it terrifying and vile!"
Mother Night by Kurt Vonnegut, Jr.

They (Women Marines) don't have a nickname, and they don't need one. They get their basic training in a Marine atmosphere, at a Marine Post. They inherit the traditions of the Marines. They are Marines.
LtGen Thomas Holcomb, USMC
Commandant of the Marine Corps, 1943
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ronnywhite
SFN Regular

501 Posts

Posted - 11/04/2005 :  23:47:58   [Permalink]  Show Profile Send ronnywhite a Private Message
This was a good post, and another issue it reminded me of involves the privately-operated blood plasma centers. I'd gone to them a few times in the past (it's been a long while) but I wouldn't again. The blood constituent-based products which are produced from plasma are valuable and necessary, and donating plasma regularly can be (speculatively) beneficial to health, although I've never really looked into just how well-founded the claims are. But there's a darker side to these places.

First, I read of the gross-cash paid for a plasma donation by companies that produce biologics, and as compared to what individuals are paid for donations, it was staggering. Of course, these places have their overhead, and granted, I don't know what their profit-margins are, but when I looked at the people donating their plasma, it seemed apparent that many did so out of desperation for the stipend, which is a minimal amount and is "market determined." I noticed the protein percentage on an analysis sheet and the donated volume, and it occured to me that it (almost, but not quite) made doing so for food counterproductive, depending upon a person's diet. Many of those donating probably weren't very health-conscious, and doing so might very well be benefiting others health, to the detriment of their own in some instances. Of course, if analysis deems their plasma constituents are deficient, they are not allowed to donate. But the entire scenario, considering the clientele, had a disconcerting aire of exploitation of the desperate. One could argue that issue both ways, I suppose- but I'm not impressed.

Moreover, basically, these places perform what amount to invasive procedures on a "Burger King" like "(dis)assembly-line" basis. I'm sure they have their safety standards and protocol, but subjectively, I left with the impression that this is a context one might have reason to wonder about the needles and equipment they are being connected with, and the people doing it.

While I was being "siphoned," I heard those operating the equipment answer medical questions by clients with nonsensical answers, instead of saying "I don't know." Since one of my blood tests had come back elevated, I was told by an employee I'd need to speak with "the doctor" before donating... I addressed him as "doctor" and he didn't indicate he wasn't one, but rather had a suspiciously defensive demeanor and seemed to "dodge" a medical question I asked him. Afterwards, I asked a different employee if the man had been a physician, and she told me he was "a nurse." I mentioned this to a few clients, who said another person had confronted him with this, and had been told "Oh yea, just try and sue us."

I'd heard and seen enough. I'm sure there are some who'd argue as to the beneficial role and safety of these places, but personally, I have my doubts- and probably wouldn't donate plasma again, other than in a hospital, perhaps.




Ron White
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beskeptigal
SFN Die Hard

USA
3834 Posts

Posted - 11/05/2005 :  00:53:06   [Permalink]  Show Profile Send beskeptigal a Private Message
Ronnywhite, your experience seems atypical. I am not aware of many plasma collection sites that have been the source of disease outbreaks in the USA. China yes, but not here. Clearly there was poor communication in your case but I'm not sure all the sites should be painted with the same brush.
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