Help....so scared

Oh god this is my worst nightmare.  I have dreaded this day ever since i became a nurse and hoped i would never have to go through something like this.  I am a RN and I was giving a patient a SQ insulin shot in the back of her arm, she went to get up as i was finished and the needle went into my left thumb.  My heart sank and so did my life. I knew she was HIV+ so i was freaking out right away.  As soon as it happened i bled the site and washed it with soap and alcohol.  I started PEP 2 hrs later (truvada, norvir, raltegravir, and preszita), my initial results are negative. I do not know the viral load of the patient yet, i can only pray that it is low. I know odds are 0.3% but that doesnt settle my fears, i am young and want to live a happy healthy life with KIDS! DR. please tell me if you have honstly heard of any cases like mine that have converted. I am in awe and feel like my life is totally over and ruined.  Only people in my position could ever imagine what i am going through, and NO ONE NO ONE deserves to go through this ....no one.

SQ insulin needle after injection in arm
Was wearing gloves
No visable blood on needle
I bled it right away (lots of blood squeezing hard)
Washed it right away
started PEP 2 hrs after (truvada, norvir, raltegravir, and preszita)

OMG this is my worst nightmare, i am completely freaking out, please help and PRAY please PRAY

[nursegirl6572]

RELLLLLLAAAAAAAX.

First...this isn't the Expert (doctor) forum, but maybe I can save you a few bucks...

You need to take a deep breath.  You are not going to get HIV.  First of all...needlestick injuries really do not pose a risk like people think they do...or like we learned in school.  A work-related injury that would cause concern would be a very significant injury where there was a large wound on the HCW with a VERY large amt of blood exposure (think scalpel injury with lg amt fresh blood from patient).

HIV has to make it to the bloodstream to infect.  A lil superficial poke with a super small guage needle as you would use in an insulin injection (usually 25g or smaller) is not going to lead to infection.  It just isn't.  I know you're freaked out, especially b/c the pt is confirmed POS, but please don't worry.

Follow your facility's exposure policy (which you already are doing)....and test at 3 months after your last dose of PEP (which I wouldn't necessarily agree with....but being that the pt is POS, I understand the recommendation too).  You will be just fine.

I've worked in the Employee Health Dept at a few of my jobs thru the years and have NEVER seen a situation like this turn out badly (with a sharp's injury from a confirmed POS pt).  Trust me here, you'll be okay.  Keep us updated, and please watch yourself on the PEP, you are on some seriously potent meds that can have the potential for some nasty side effects.

Hang in there.

[RNneedlestick]

Thanks so much, any words make me feel better right now.  I just dont know how deep the needle actually went, this is what worries me. And i also dont know her viral load yet. I know odds are low but they are still out there.  Would u stay on PEP for 3 months?

[nursegirl6572]

That is a tough question.  Knowing what I know and my pretty extensive experience with HIV, I probably would not. I probably would not have ever started it, however, I am not in the situation, and I know that even the most rational, educated person can do things we think we wouldn't in certain situations.  If it helps to ease your mind, then by all means, continue the course.  I just know the meds are awfully rough, considering what a non-existant risk you had.  

I've had several needlestick injuries over my career, and although none of the pts were confirmed HIV POS, one was Hep C +, and one was Hep B POS (which, as you know is pretty similar biologically to HIV).  I did take prophylactic gammaglobulin, but of course, I ended up being fine.

I once cared for a nurse when I was working in employee health that had sustained a needlestick injury from an AIDS pt with an IM needle.  She was just fine.....this was a while back, so no PEP was offered at that time.

The actual # of HCW work-related sharps type injuries that result in infection are about zero.  I did some research on this when in the employee health dept, and the ONLY injuries that I found during my (extensive) studies were very very significant injuries (again, think OR, heart cath lab, etc)  I actually never came accross any info about people sustaining SQ/IM type needlesticks that actually seroconverted.

I know you're scared, but please have some faith here.  A SQ needle isn't going to A. Have enough blood to matter, B. Make it to the bloodstream, and it only has blood on the surface area of the needle, which when exposed to the elements, quickly deactivates the virus.  If you had been drawing blood where the blood was preserved in the bore of the needle, you would be slightly at increased risk, although, even that really wouldn't pose too much of a concern.  Even those scenarios have not resulted in infection.

You'd have a better chance of getting hit by lightning, in the same place TWICE, while holding the winning powerball lotto ticket, with your dream man (woman?) waiting next to you.  You know?

Continue the PEP if it eases your mind.....and test at the appropriate time.  YOU ARE GOING TO BE JUST FINE.  Have some faith and try not to worry too much, anxiety can cause you real problems.  Keep yourself busy and do NOT surf the web endlessly...there is SO much misinformation out there it will only serve to scare you to death.  If it would make you feel better....ask your question to our docs in the expert forum.  They are both very knowledgeable and are realists....they will tell you like it is, if they truly feel you've had a significant  risk,they'll tell you.  You can also run the PEP question by them.  Again, I dont know that I agree with that, but I also certainly understand the recommendation, being that the pt is confirmed POS....it's just an added precaution, andprolly more than anything, will help ease the anxiety.

[RNneedlestick]

I greatly appreciate your responses.  Taking your time to try and calm me down is very supportive and much appreciated! I do feel alittle better, but i have some terrible moments. I guess that i will have these terrible moments for the next few months.  I just wish that if it had to happen than it could be over already. Your amazing....thank you

[Teak]

PEP is never given for 3 months. PEP is given for 28 days only.

[RNneedlestick]

Thankyou Teak. What do u think about my stick?? I am so nervous