Don't reuse that blood tube holder

Nursing, Aug 2003 by Perry, Jane, Jagger, Janine

AFTER YOU DRAW blood, the blood tube holder provides your only protection from the back end of the phlebotomy needle. Removing the needle in order to reuse the holder poses a risk, even if it's a safety-engineered needle. The tube-puncturing back end of the needle is exposed, and its rubber sheath provides little or no protection.

An analysis of 9 years of data from 90 facilities reporting to the Exposure Prevention Information Network (EPINet) reveals that 94% of all phlebotomy needle injuries involved blood-filled needles, which pose the greatest risk of transmitting bloodborne pathogens. Disassembling the device caused 11% of these injuries, more than double the rate in this category for all other devices.

Phlebotomy needles accounted for more disposal-related injuries (22%) than other devices (15%) too. In particular, 17% of phlebotomy needle sticks occurred while the needle was being placed in the sharps container, compared with 7% for all other devices.

With some disposal systems, you eject the needle from the holder into a sharps container. Others have a notched unwinder you use to twist or pull back the tube holder to release the needle. Neither type has an integrated needle safety feature, as specified in the OSHA's Bloodborne Pathogens Standard.

Numeric data on phlebotomy needle injuries don't tell us which end of the needle injured the worker, but 114 written statements from injured workers indicate that at least 10% involved the back end. An additional 6% specify that the injury occurred while removing the needle from the holder but not which end of the needle stuck them.

Unless another shielding mechanism is provided to cover the back end, the phlebotomy needle and tube holder should be disposed of as a unit to minimize high-risk injuries. If your facility calls for reusing blood tube holders, advocate for a change.

BY JANE PERRY, MA, AND JANINE JAGGER, MPH, PHD

Janine Jagger is director and Jane Perry is director of communications at the International Health Care Worker Safety Center at the University of Virginia in Charlottesville. The safety center and its quarterly journal, Advances in Exposure Prevention, are devoted to the prevention of occupational exposures to bloodborne pathogens. For more information, call 434-924-5159 or point your browser to http://www.med.virginia.edu/epinet. The Web site includes an exposure prevention checklist that can aid you in your compliance efforts.