What happened? Report reveals differing practices
What happened? Report reveals differing practices
Two Epidemiologic Intelligence Service officers from the Centers for Disease Control and Prevention visited the Endoscopy Clinic of Southern Nevada in Las Vegas to investigate cases of hepatitis C and noted lapses in injection safety. Practices differed among the nurse anesthetists. This is an excerpt of their report:
- Before placing IVs, RNs or CRNAs generally wore gloves, but one CRNA was observed not to do so. They cleansed the patient's skin with alcohol. They did not have safety-locking needles, but most disposed of needles into proper receptacles. However, one CRNA was observed moving about the room with an uncapped needle.
- CRNA 1 was observed placing a new needle on the same syringe that had been used to administer initial sedation to a patient. This syringe then was used to withdraw additional propofol from an open propofol vial for the same patient. When questioned, the CRNA indicated that reuse of syringes in this manner for an individual patient was his routine practice and reflected what clinic staff had instructed him to do. According to an interview with the CRNA, if the patient did not require more sedation, the CRNA disposed of the needle and syringe, but kept the remainder of the propofol vial in order to use it for the next patient.
- CRNA 2 was observed using several new syringes to withdraw propofol in addition to the syringe that contained the lidocaine and propofol. These additional syringes filled with propofol were then available if the patient required additional sedation. CRNA 2 disposed of partially used syringes, but kept the unused ones for subsequent patients. CRNA 2 also reported having been instructed to reuse syringes to administer multiple doses of propofol to an individual patient, but did not do so.
- CRNA 3 was observed drawing additional doses of propofol for an individual patient with a new needle and syringe as needed. CRNA 3 reused propofol single-use vials between patients after wiping the stopper with alcohol and used a new needle and syringe each time.
- CRNA 4 no longer worked at the Clinic and had moved out of state. By phone conversation, CRNA 4 reported a practice similar to CRNA 1. CRNA 4 would reuse a syringe to access propofol if a patient required additional sedation. The CRNA would discard the syringe at the end of the case, but would use the remainder of the propofol vial on subsequent patients.
(Editor's note: A full copy of the CDC report is available at health.nv.gov/docs/FinalEpi2_20080515.pdf.)
Two Epidemiologic Intelligence Service officers from the Centers for Disease Control and Prevention visited the Endoscopy Clinic of Southern Nevada in Las Vegas to investigate cases of hepatitis C and noted lapses in injection safety. Practices differed among the nurse anesthetists. This is an excerpt of their report:Subscribe Now for Access
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