[optimal] Re: When to remove needle
- From: "Curtis, Rhonda" <Curtis@xxxxxxxxxxxxxxxx>
- To: <optimal@xxxxxxxxxxxxx>
- Date: Fri, 10 Jun 2011 09:20:37 -0500
Before I started injecting myself, some of residents would inject, pull the
needle and leave during the transit. The only needle sticks occurred when this
was done – once they got me reaching for the disposal – several times they
stuck their own fingers. Fortunately, this was before the AIDS epidemic.
After the third stick – I would not let them do this any longer, and I would
just remove after the transit.
Rhonda
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On
Behalf Of Michael R. Turano Jr.
Sent: Friday, June 10, 2011 8:55 AM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: When to remove needle
I would leave it in during transit as I wa doing my own injection. Then during
wait time before miss I would remove,discard and tape or bandage gauze down and
fold patients arm up. Elbow resting on pad. Then resume photography. If I was
in the room with another photog I would remove for them while they were
shooting and usually push.
It shouldn't really distract the patient I would just use judgement. On an
unstable/easily distracted patient no issue leaving in. On a cooperative
patient remove when you can. It's just like anything else read the situation,
communicate with patient and with assistant if you are lucky to have one and go
from there.
Mike
Michael R. Turano, Jr., CRA, OCT-C
Imaging Specialist
C 917.826.9506
F 917.591.1841
turano@xxxxxxxxx
Sent from my iPhone
On Jun 10, 2011, at 9:25 AM, "Peterson John C" <JPeterson@xxxxxxxxxxxx> wrote:
Alexis, I'm referring to a case where I am injecting for a fellow
photographer. We do our FAs as a 2-person procedure.
********
John C. Peterson, BS, CRA
Director of Ophthalmic Photography Services
UW Health Eye Clinic
2880 University Ave., Rm. 246
Madison, WI 53705
(608) 263-7163
________________________________
From: optimal-bounce@xxxxxxxxxxxxx
[mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of Alexis Smith
Sent: Thursday, June 09, 2011 2:59 PM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: When to remove needle
My question is for those of you doing the injections yourself: how do
you capture a transit if you are removing the needle and pressing down on the
cotton for thirty seconds or so? I usually need both hands to capture and to
lift an eye lid; having one hand putting pressure on the injection site after
needle removal while taking photos, adjusting exposure, and potentially helping
with eyelids is tough! I've only taken the needle out right away on extremely
skittish or young patients who are moving around. Otherwise, I wait until I
have captured the transit.
Alexis
On Thu, Jun 9, 2011 at 3:46 PM, Peterson John C
<JPeterson@xxxxxxxxxxxx> wrote:
You remove a butterfly needle once the syringe is empty because a
butterfly needle is not intended for extended placement. Two minutes seems not
unreasonable. We've had no problems taking it out right away, and our skittish
patients are happy to hear us say "needle's out!". Flinching has never been an
issue
Just my inflation-adjusted 3 cents....
********
John C. Peterson, BS, CRA
Director of Ophthalmic Photography Services
UW Health Eye Clinic
2880 University Ave., Rm. 246
Madison, WI 53705
(608) 263-7163
________________________________
From: optimal-bounce@xxxxxxxxxxxxx
[mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of Ethan Priel
Sent: Thursday, June 09, 2011 1:49 PM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: When to remove needle
Follks,
We have been using metal butterflies for decades. Thousands a month.
We use the plastic catheters for all first-timers, anyone with history
of allergy or serious medical conditions.
We NEVER take the needle out 'immediately' for the highly-intelligent
reasons listed earlier –
- Secure open vein in case
- Discomfort that can cause patient to balk (I guess the
Bostonians are hardier stock)
- If it ain't broke, don’t fix it.
Now, I think that the sharp is in the other court –
WHY take the needle out right away ?
Ethan
From: optimal-bounce@xxxxxxxxxxxxx
[mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of Cavicchi, Robert
Sent: 09 June, 2011 17:32
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: When to remove needle
We use the same procedure as John describes below…
Removal of the needle immediately following the injection and we don’t
have any patient complaints about stinging/pain.
No problems acquiring the A-V phase either.
bob
From: optimal-bounce@xxxxxxxxxxxxx
[mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of Peterson John C
Sent: Thursday, June 09, 2011 10:27 AM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: When to remove needle
We always remove the needle right away. I believe that some of the
"ouch" you describe is the sting from FA dye left in the needle. We routinely
draw back a bit of blood to clear the dye out of the needle bore.
No complaints from our patients so far.
********
John C. Peterson, BS, CRA
Director of Ophthalmic Photography Services
UW Health Eye Clinic
2880 University Ave., Rm. 246
Madison, WI 53705
(608) 263-7163 <tel:%28608%29%20263-7163>
________________________________
From: optimal-bounce@xxxxxxxxxxxxx
[mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of Richard Morrone
Sent: Thursday, June 09, 2011 9:14 AM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] When to remove needle
Hello all,
After decades of performing FA's I have recently received resistance from
nursing at one facility regarding my request that the nurse not remove the
butterfly during the first minute or two so as not to distract the patient
during the rapid sequence of flashes in an FA.
I have had patients look down at the arm or be startled or even say "ouch!"
when the needle is pulled. Nursing does not believe that that would occur.
They seemed concerned about the metal needle of our 23g butterfly being left
in, and they want to remove the needle immediately after injecting. They said
that to do otherwise would put the patient at risk. So much for getting the
A-V phase with all of that activity occurring.
I could suggest the use of angiocaths (with the soft plastic needle/sleeve) to
address the metal needle concern, but they do cost more.
Does anyone have a sample protocol that mentions when the "needle" is removed?
Or... can you just describe your procedure?
Thanks,
Richard Morrone, C.R.A.
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