PUNCTURE INJURIES DUE TO NEEDLES REMOVED FROM INTRAVENOUS LINES - SHOULD THE SOURCE PATIENT ROUTINELY BE TESTED FOR BLOODBORNE INFECTIONS

OBJECTIVE: To better assess the risk of exposure to bloodborne pathoge ns following puncture injuries due to needles removed from intravenous (IV) lines. SETTING: Tertiary care community medical center. PATIENTS : A convenience sample of hospitalized patients requiring IV piggy-bac k medications. METHODS: Examination of 501 IV ports of peripheral line s, heparin-locks, and central venous lines for visible blood and testi ng the residual fluid in the needles removed from these ports for the presence of occult blood by using guaiac-impregnated paper. RESULTS: T he proximal ports of central venous fines and heparin-locks were stati stically more likely to contain visible blood than proximal and distal ports of peripheral lines (17% and 20% versus 1% and 3% respectively, P<0.05). Similarly, needles removed from proximal ports of central ve nous lines and heparin-locks were statistically more likely to contain occult blood than those from peripheral lines (11% and 14% versus 2%, respectively, P<0.05). Only two needles removed from IV lines without visible blood contained occult blood: one from the proximal port of a central line and another from a hepatin-lock. None of the needles fro m peripheral lines without visible blood contained occult blood. Estim ation of the risk of transmission of hepatitis B and C and human immun odeficiency virus (HIV) following injury by needles from various IV li nes revealed that injury due to needles removed from peripheral IV lin es and distal ports of central lines without visible blood was associa ted with ''near zero'' risk of transmission of these bloodborne infect ions at our medical center. CONCLUSIONS: Routine serological testing o f source patients involving injury due to needles removed from periphe ral IV lines and distal ports of central lines without visible blood i s not necessary at our medical center. Conversely, due to the relative ly high rate of occult blood in the needles removed from proximal port s of central venous lines and heparin-locks, puncture injuries due to these needles are considered significant and managed accordingly.