CDC: Nurse anesthetists' practices varied at clinic
Direct observation by EIS officers
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. The investigation has resulted in eight confirmed HCV cases and a look-back investigation involving more than 40,000 patients. The CDC investigators noted in the May 15, 2008, report that practices differed among the certified registered nurse anesthetists (CRNAs). This is an excerpt of the CDC 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 routine practice and reflected what clinic staff had instructed. 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.
Those additional syringes filled with propofol then were 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: http://www.health.nv.gov/docs.)
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.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content