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RN exposed to end-stage AIDS pt's blood, PLEASE ADVISE
Aug 29, 2007

Hello Dr. Frascino,

I am an RN in an ED. 4 days ago, I was holding pressure on an end-stage AIDS pt's artery after a resident had tried to put a fem line in and gotten an artery instead. All sharps had been removed from the area before I had begun to hold pressure. After holding pressure for about 5 minutes, I removed my gloves to find my glove had either worn through or had been popped by my fingernail. The pt's blood was all over my index finger. I immediately washed the finger and reported to employee health, where I was put on PEP. As far as I could tell, all the skin on my finger was intact, however, the blood was all around my cuticle. Please evaluate my risk. I can find lots of figures about percutaneous exposures, but not much for my type of exposure. I am a brand new nurse (it was only my 5th day) so I would really appreciate any advice. Thank you so much! -CK

Response from Dr. Frascino

Hello CK, RN,

Yikes!!! The resident was trying to put in a femoral line and hit the artery instead????!!! Chances are he or she was a new and obviously not very experienced resident. I'll bet the attending physician was less than pleased and I feel so very sorry for the poor patient.

Regarding your HIV-transmission risk, I'm glad you immediately washed the blood from your finger and reported to employee health for an evaluation. If indeed the skin on your finger was intact, your HIV risk would be essentially nonexistent and I would not have recommended PEP. As with all potential HIV exposures, both occupational and non-occupational, that are felt to be significant enough to warrant a course of PEP, I would encourage you to consult an HIV specialist. Chances are you have one on staff. The HIV specialist will once again document and evaluate your potential risk and advise whether PEP (or continuation of PEP) is warranted. If continuation is warranted, he will optimize your PEP regimen based on the patient's current meds and resistance profile, if known. He will also monitor, evaluate and manage any PEP-related side effects and/or toxicities. Finally, he will arrange for and interpret recommended post-PEP HIV testing.

Good luck! (to both you and the clumsy resident!).

Dr. Bob



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