Skin Needling Consent: Fill & Download for Free

Many times. My first time (like most first times) was the most memorable. I was an intern sewing up a laceration in the children’s hospital emergency department. The child I was working on had been remarkably calm. She didn’t even move or make a sound when I started anesthetizing her wound with lidocaine. I was becoming more and more confident with each pass of the needle. As I was finishing up with the last injection she suddenly screamed and pulled her arm away. When she did this, I pulled the needle out of her wound and as I sort of rebounded I drove the needle right into my left hand. My right thumb was on the plunger of the syringe and I was applying pressure so, when the needle plunged into my hand I injected myself with a used, hollow core needle.I rapidly pulled the needle out of my hand as though maybe I could reverse what had happened. I could almost immediately see my own blood spreading out between my skin and the translucent, rubber glove. I felt hot all over. I thought I might get sick. I excused myself and took off my glove at the sink and started washing my hand. I squeezed the injection site and stimulated more bleeding. I hardly needed to though. It seemed to bleed really freely. I excused myself from the room and went to talk to my attending. The policy at that time was to obtain “source blood” for Hepatitis and HIV testing. I would also be tested and start on medicine for HIV prophylaxis if the patient was high risk and then be re-tested in six months. I felt fortunate that my patient was a toddler. That felt really low risk. But, after my attending interviewed the mother to obtain consent for testing, he told me she was a prostitute. So, I ended up on HIV prophylaxis.I was pretty freaked out for a few days, but as the tests all started coming back negative I felt better. I almost forgot to get redrawn in six months. By that time I had already had another needle stick.

I’m an operating room nurse. Most people are unaware of what I do at work. There are two different roles I assume per surgery - circulator or scrub, so for one case I might be the circulator and for the next case I might be the scrub.The circulator prepares and manages the OR theatre, prepares medications, open supplies for the scrub, assesses the patient, confirms the consent/npo status/allergies/void of all jewelry/dentures/contacts, brings the patient to the theatre, applies blood pressure/oxygen saturation/ecg monitors, aids anesthesia in induction, disinfects the operative site on the patient with either chlorhexidine or iodine, manages patient positioning and surgical equipment, documents the procedure, and fixes any problems that might occur during the surgery. All of these tasks must be done for every surgery, additionally I haven’t included managing other types of specialized equipment set ups (ie. Liposuction machines or cystoscopes, etc).The scrub nurse sets up all of the instruments on the sterile table before the procedure, stays sterile, and passes instruments to the surgeon. You’ve gotta know all the instruments, all their names, and the surgery procedure itself so that you can anticipate what the surgeon needs before they even ask. Most are awesome and verbalize what they want (ie. “Debakey” or “3–0 vicryl”) but sometimes they don’t even ask and just hold out their hand expecting you to know. The scrub counts all the sponges, needles and instruments with the circulator before the surgery and during closing of the cavity to ensure nothing is left behind. Sometimes it’s an extensive count because there are so many instruments. For example, the peritoneal instrument pan includes scalpel handles, scissors including mayos, metzenbaums, tissue forceps including adsons, debakeys, bowel, mackabees, bonny’s, clamps including mosquitoes, snaps, Kelly, kocker, Allis, Babcock, suction, lahey, ring, towel clips, needle drivers, retractors including malleable, parker, poole, langenbacks, richardson, squareface, and then we continue to the skin count which includes sponges, needles, blades, etc.Both roles are challenging, fun, and require critical thinking at all times. It does seem like a lot, and it is overwhelming at first. However, with lots of time you get used to the tasks at hand. 80% of the time I work 8 hour day shifts from 7am - 3pm, 10% of the time I work evenings from 3–11pm with some days on call (11pm-6am) and 10% of the time I work 9am - 5pm late day shifts. Lunches are 30 min, and scheduled breaks are 15 min one in the morning and one in the afternoon. Sometimes we miss our breaks due to how the case is going.As an OR nurse, we are immune to the sight of scalpels, sharp instruments, blood, internal body parts, nudity, and unpleasant odors, and we are pretty good at suppressing our own bodily functions such as hunger or needing to use the bathroom. Nothing fazes us. Except dirty belly buttons. You have to have thick skin and not take anything personally as there are lots of strong personalities and OCD behaviors with the surgical team. It’s a very team-based approach to surgery and everyone relies on each other for the best possible outcome. During surgery we talk about anything and everything and the mood can be light or serious depending on the procedure. The level of sterile awareness is on a whole other level in the OR (germaphobe alert!) and in time you will start to routinize other aspects of your life to increase efficiency and be meticulous.After seeing so many surgical procedures, you start to change your lifestyle (for example, increase fibre and reduce meat consumption to avoid colon cancer) so that you can avoid such procedures in the future. Being an OR nurse requires full mental concentration the entire time while at work, you’re always “on” and so after work you’re very exhausted. Also, as an OR nurse you change into the hospital-issued scrubs and change out when you’re done for the day. We wear masks in the OR theatre, and scrub caps to cover our hair. Therefore, we never get to see what our coworkers look like without the hair up and in street attire. Treats (like chocolate) in the nursing lounge are much appreciated.Outside of work, being a nurse means that you are constantly assessing, whether it’s the situational environment, people, one’s health, and you can react to emergencies in a calm, controlled manner. The anticipation will come naturally. Nurses love sleeping and eating more than the typical person. We love nurse memes because they are hilarious and true. To be an OR nurse, it is a very specialized area of nursing and difficult to get into. You need a bachelors of science in nursing, and most nurses will take the perioperative course afterwards as a prerequisite. I was lucky to have been placed in the OR field in my final practicum of nursing school (there was only one spot in my graduating class for pediatric OR) and I was beyond ecstatic to have had that opportunity. I find being an OR nurse very rewarding and challenging and the only thing constant is change.

There are many options for the reduction and camouflage of scars depending on the type, severity and location site.If the scar is fully healed (minimum of 1 year) and lighter in colour than the surrounding area then you are a great candidate for permanent camouflage. The technique uses micro dots of custom blended pigment to blend the scar tissue with the surrounding skin.Skin Needling/Collagen Induction Therapy has also shown excellent results in smoothing the texture of scars. This can be performed with derma rollers or digital needling - micro needles penetrate the dermal layer of skin (usually 1.5mm - 2.5 mm) triggering the skins healing response to create collagen and elastin.Candidates for these treatments include:Post operative scars (face lift, mastectomy, cleft lips)Contracture scars - burnsSelf harm scarsScalp - trauma or hair transplantAcne scarsStretch MarksIf your scars are hypertrophic (raised) you may need additional therapies such as cortisone injections to assist with healing.www.borcianilondon.comIt is not possible to treat Keloid scars as this may lead to the Keloid being aggravated and spreading to other areas.Before proceeding with any treatments, make sure a thorough consultation has been performed, it may be necessary to obtain your doctor's consent.