Fundamentals - Principles, part 14: Sharps Injuries, Body Mechanics, and Brachytherapy
by Meris Shuwarger BSN, RN, CEN, TCRN July 19, 2021 Updated: December 07, 2022 7 min read
In this article, we cover sharps injuries, how to avoid getting injured, and what to do if you are injured by a needle or other sharp. We explain proper body mechanics and why they are important to prevent injury, especially to your back. And we cover how to care for patients undergoing internal radiation, sometimes called brachytherapy.
The Fundamentals of Nursing video series follows along with our Fundamentals of Nursing flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
A sharps injury is when you accidentally puncture yourself with a needle. It is very important to understand how to prevent sharps injuries and how to care for them.
Injuries from needles and other sharp medical devices present serious health risks and are an important occupational hazard to watch out for. If you are punctured by a sharp, also known as a percutaneous injury, you are at risk of serious complications, including Hepatitis B and C, or HIV.
Preventing sharps injuries
Whenever possible, use needleless systems. A needleless system is one that does not use needles to administer medication, for example, an IV access device that delivers medication through a port that is surgically implanted in a patient’s body. Additionally, safety-engineered needles are commercially available and effective at reducing needle sticks. If it is not possible to use a needleless system, use extreme care when handling needles and sharps of any kind.
Many needles come with safety features as integral parts of the device. Among the most common safety features are re-sheathing devices. Re-sheathing devices are shields that cover the needle or retract the needle after use, such as a needle cap and safety lock. If you are starting an IV or giving medication through a needle, you are likely using a system that has a safety feature. Always use the safety feature and be sure to deploy it immediately after you are done using the needle.
Do not recap needles after use. Immediately dispose of it in the used sharps container instead.
If you are in a situation where you must recap a needle, for example, there is no way to dispose of it immediately, recap it using the “scoop” or “swoop” method.
Lay the cap on the table. With one hand, scoop up the cap onto the needle. Then, once the cap is resting on the needle, snap the cap onto it.
Remember, only recap the needle if there is no other way to dispose of it immediately.
Once a needle is used, immediately place it in the sharps container.
A sharps container is a hard plastic container that is used to safely dispose of hypodermic needles and other sharp medical instruments. It is often sealable and self-locking. You will recognize a sharps container by the universal biohazard symbol on the front.
Dispose of used needles in the sharps container. When the sharps container is full, it's important to report it immediately, so it can be replaced.
What to do if you get a sharps Injury
If you are injured by a sharp, the first thing to do is irrigate the injury site (e.g., your hand) with warm water or normal saline.
Next, immediately report your injury to your supervisor, charge nurse, or nurse manager. Even if the injury seems minor to you (e.g., there is no patient blood on the sharp), report it.
If you do get a sharps injury, seek immediate post-exposure prophylaxis to learn if you have any complications from your injury.
Post-exposure prophylaxis means, literally, treatment following exposure (e.g., a needle stick). Prophylactic means preventive; so prophylactic care refers to any procedure or treatment meant to prevent something from happening. Common examples of prophylactic care include dental cleanings, vaccines, and birth control meant which prevent tooth decay, infectious diseases, and pregnancy respectively!
Post-exposure prophylaxis procedures (after a sharps injury) may include blood work or taking medications.
It is important to report a sharps injury because of the possibility of serious complications, including Hepatitis B and C, or HIV.
Proper body mechanics
Body mechanics are the way you hold your body when you sit, stand or move around. Proper body mechanics can help you avoid muscle fatigue or injury when you perform daily tasks, like lifting heavy objects, moving patients, twisting around to see something, or even sitting in a chair for a long time.
Understanding and employing proper body mechanics helps you protect your body from injury as a nurse.
The important body mechanics you need to know about are how to stand properly, how to protect your back, and pivoting without twisting the spine.
Did you know that there's a right and a wrong way to stand? You might call this “good posture.” Standing properly is a body mechanic that will help relieve stress on your spine, increase circulation, and decrease muscle fatigue.
To stand properly, stand with your feet shoulder-width apart. This provides you with a wide base of support. Avoid standing with your feet close together — standing with a narrow base means you could lose your balance.
Protecting your back
You only have one back, so protect it! Using proper body mechanics when lifting or twisting will help you avoid back pain and prevent injury to your back.
Repeatedly bending over to help your patients will strain your back over time. When providing bedside care, make sure that the patient's bed is set to the appropriate height. Setting the bed height to your waist level ensures that you won't have to repeatedly bend over and risk straining or injuring your back.
When lifting, use your legs instead of your back. You use your legs by bending at the knee and squatting down. Avoid bending at the waist to pick something up, as this puts strain on your back.
If you need to lift something heavy, hold it close to your body when you pick it up. If there is an assistive device available, like a transfer belt or lift equipment, use it.
If you have to move a patient, make sure there are enough caregivers to assist with patient transfer.
Pivot without twisting the spine
It's okay to pivot a little when you provide care. For example, you might pivot a little when you are moving a patient. Try to avoid twisting your spine — that's when your base of support (your shoulder-width-apart feet) does not move, and you have to twist your back to move. This is another way that you could hurt your back. It is better to take steps in the direction of the turn, instead of twisting your spine, in order to avoid injury to your back.
Internal radiation or brachytherapy
Internal radiation, sometimes called brachytherapy, is when a patient has a sealed radioactive device implanted in their body in order to provide short-term, targeted radiation therapy. Brachytherapy may be used as a treatment for endometrial, cervical, ovarian, or breast cancer.
Radiation is very dangerous, so you will have to be extremely careful when you provide care to a patient undergoing this therapy. Exposure to radiation can lead to acute radiation syndrome, also called, “radiation sickness.” It can also result in long-term health effects such as cancer and cardiovascular disease.
Keep the patient in a private room
A patient undergoing internal radiation or brachytherapy should be kept in a private room with the door closed. Do not put the patient in a semi-private room, because you don't want to expose a roommate to radiation.
Cluster your care
If you have a patient undergoing brachytherapy, it's important to cluster your care. This means consolidating your care tasks for this patient so they can all be accomplished in one visit, so you are not entering and leaving the room repeatedly.
Limit your care time to 30 minutes total in the room if possible.
When you go into a patient's room, you should wear a dosimeter badge. A dosimeter badge tells you how much radiation you have been exposed to. You need to know if you are being exposed to unsafe levels of radiation.
Your patient won't need to wear a dosimeter badge, because we already know they're being exposed to the radiation.
You should wear a lead apron at all times when providing care for a patient undergoing internal radiation or brachytherapy. Lead aprons protect you from unnecessary radiation exposure. It is important to remember that exposure to radiation can result in long-term health effects such as cancer and cardiovascular disease.
You've probably worn a lead apron before when getting X-rays at the dentist! If you've ever worn a lead apron, you know that it covers you in the front, but it does not cover your back completely.
Because only your front is protected, make sure that you are facing the patient at all times and not turning your back to them, because if you turn your back on them, your back could be irradiated.
Visitors must remain six feet away from a patient with a brachytherapy device at all times, and they should limit their visits to less than 30 minutes.
Do not let children under the age of 18 go into the room. Radiation is particularly harmful to children because they are more sensitive to its effects than adults. Radiation lasts longer in a child's body, meaning they are more susceptible to radiation sickness or cancer over their lifetime.
No one who is pregnant should enter the room. This pertains both to care providers and visitors. So if you are pregnant, do not enter the room!
What to do if the radiation implant becomes dislodged
If the radiation implant becomes dislodged and is outside of the patient's body — perhaps on the floor — use long-handled tongs to pick it up and place it in a lead container. Always ensure that there is a lead container in the room in case of such emergencies. Next, call the provider.
It is extremely important that you provide for the patient's safety and your safety by making sure that the implant goes inside a lead-lined container so that it is not irradiating anyone in the room.
Hi. I'm Meris and in this video, we're going to be talking about sharps injuries, proper body mechanics, and caring for patients undergoing internal radiation sometimes called brachytherapy.
I'm going to be following along using our Nursing Fundamentals flashcards. These are available on our website LevelUpRN.com. If you already have them and you want to follow along with me, I'm starting on card number 39. So let's get started.
Okay, so first up we're talking about sharps injuries. Now, these are very important to understand how to prevent as well as how to care for them.
So first and foremost most things in the hospital that could hurt you have some kind of a safety function. So if you are starting an IV or giving a medication that has a needle you very likely are using some kind of a system that has a safety feature. So be sure to use that safety feature. Deploy it immediately after you are done with the needle.
Also, we don't recap needles whenever possible. In the NCLEX world you're never recapping a needle.
And if for some reason you did need to recap it you would use the scoop or swoop method where the cap is going to be laying on the table and using one hand you're going to try and scoop up the cap onto the needle and then once it's already on the needle then you would cap it.
That's only if it is completely unavoidable. We also dispose of everything immediately in the sharps container. And when it is full we report that so that can be replaced. Very important.
Now, what do I do if I get a sharps injury? So the first thing I'm going to do, I'm immediately going to rinse my hand or wherever I was injured, using either water or normal saline.
And then, I'm going to go immediately to a charge nurse or nurse manager, whoever is directly above me in that moment, and report the injury, even if you don't think it's a big deal, even if there was no patient blood on it or anything.
You're reporting it no matter what because there are serious complications that can come from sharps injuries, and you need to make sure that you undergo post-exposure prophylaxis.
This might mean blood work. It might mean medications. There's a lot of things that can be done to see if you have any sort of complications from your injury and if you need any treatment.
So always, always, always report it to whoever is your immediate supervisor after it happens.
Okay. So moving on, we're going to be talking about proper body mechanics.
It's very important to understand proper body mechanics because this is how to protect you, yourself, as a care provider. So one of the things we want to do is make sure that our feet are shoulder-width apart. That gives us a nice, wide base of support. We never want a narrow base.
If we ever have to lift anything, we're going to do that using our legs by squatting, and not our backs by bending over. We always want to make sure to raise the bed to an appropriate height when we provide care.
You only have one back so protect it because, yes, maybe one time bending over to do something for your patient is not going to hurt your back forever, but if you're doing it all the time, you're really going to hurt your back.
So make sure that you raise the bed up to your waist level when you're providing care so that you are not bending over.
Any time you need to ambulate a patient or anything like that, make sure you have an appropriate number of care providers to help you.
And then also, we pivot slightly when we are moving a patient, but we never want to twist at the spine. A little bit of a pivot is okay, but anything where we are actively twisting and our base of support is not moving, that's not going to be in our best interest.
Okay. So moving on now to card number 41. I'm going to tell you right now, this card is covered in red text because this is very important for your nursing exams and the NCLEX.
This is a concept that I personally struggled with a lot. It took a lot of review because there's a lot of stuff to know about it, so if you find that this concept is tricky for you, definitely keep practicing.
So internal radiation, sometimes called brachytherapy, is going to be when a patient is given a sealed radioactive device that is placed inside their body in some capacity in order to provide short-term but targeted radiation therapy.
Very important things to know because this is going to be really dangerous. Right? This is dangerous because it's radioactive.
So the patient should be kept in a private room with the door closed meaning that we are not giving a semiprivate room, they don't have a roommate, and that door is kept shut at all times.
We're going to cluster our care so that we can get lots of things done at once so we're not going in and out of the room multiple times because we want to limit our care time to 30 minutes total if we can in that room.
Obviously, that's not always going to be possible but that's kind of the standard we're hoping for.
When you go into a patient's room you as the care provider should wear a dosimeter badge.
A dosimeter badge is going to tell you how much radiation you have been exposed to. So I don't need my patient to wear it because we already know they're being exposed to the radiation.
But I need to know in case I'm being exposed to unsafe levels of radiation.
The other thing is that I should be wearing a lead apron at all times. And if you've ever worn one you know that it completely covers me in the front but it does not cover my back all of the way.
So I want to make sure that I am facing the patient at all times not turning my back to them because then my back could be being irradiated when I am looking away from them.
When it comes to visit visitors. Visitors must be six feet away from the patient at all times, and they should limit their visits to less than 30 minutes.
No children under the age of 18 should be going in, and nobody pregnant, care providers or visitors, should be going in.
We do not send pregnant people into the patient's room if they are having brachytherapy.
And then one more super important thing to know, if that radiation implant should become dislodged and now it is out of the patient, on the floor, something like that, I'm going to want to use long-handled tongs to pick it up and place it in a lead container, meaning the lead container should be in the room already, and then I call the provider.
The first thing I need to do is provide for the patient's safety and my safety by making sure that that implant goes in a lead-lined container so that it is not irradiating everybody around.
Okay. So that is it for sharps injuries, body mechanics, and brachytherapy. I hope that review was helpful. This is all very important information.
So if you like this video, please give it a like. And if it's there's something that helped you remember one of these concepts, I would love to hear it in the comments below. It would make my day.
In my next video, we're going to be talking about the nursing process, the interdisciplinary team, SBAR communication, and continuity of care.
We're going to be transitioning from the principles section of the deck to the practice and skills section of the deck. So you don't want to miss it, I promise you. Make sure you subscribe to the channel to be the first to know. Thanks so much, and happy studying!
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