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Scared New Graduate Nurse

Aug 31, 2011

I am a new nurse and scared half-to-death. I was with another student who was injecting medication into a subclavian triple-lumen IV catheter on a patient with end-stage HIV disease. After the injection, she flushed the line with normal saline leaving about 1 mL in the syringe. As she was taking off her gloves, the syringe was still in her hand and she accidentally squirted me in the face with it. I immediately went to the sink and splashed my face and eyes. I can't be absolutely certain if it actually got into my eyes - I was wearing contacts and I'm used to things in my eyes. I went to the ER, and they told me that it is extremely unlikely that I could catch HIV in this manner. They did start me on PEP (Combivir and Viracept) just to be absolutely sure my risk is as small as possible. I hate to bother you with this question - I did filter through all the board questions/answers and did not find a situation quite like mine. Honestly, I feel PEP is overkill just by the reading on the CDC website. Thank you so much for your time - I am sure you get questions like this all the time. Signed - Worried New Nurse

Response from Dr. Frascino

Hello, Worried New Nurse.

I absolutely agree with you. PEP is not warranted. When in doubt it's wise to begin PEP, as it is most effective when begun as soon as possible after an HIV exposure. If, however, a more thorough evaluation by an HIV specialist subsequently reveals there was no significant HIV risk, PEP should be discontinued. I recommend anyone who has had an HIV exposure (or potential exposure) significant enough to warrant starting a course of PEP be evaluated and followed by an HIV physician specialist. See link below. Based on the information provided I'm confident an HIV specialist would advise you discontinue PEP. Follow-up HIV-antibody tests out to six months per the occupational exposure guidelines is the most that would be recommended.

Good luck and welcome to the wild, wacky and wonderful world of medicine.

Dr. Bob

Baseline HIV Testing before giving PEP? (PEP AND THE NEED FOR HIV SPECIALIST, 2011) Feb 6, 2011

hiv test results altered by use of acyclovir to treat primary hsv outbreak?
I am positive but wife is negative

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