Reuse Lancet Devices: Can we do it?
Humans produce too much waste. And if we don’t want to be living in a planet-sized garbage dump within the next couple of hundred years, we need to reduce, reuse and recycle as much as we can. That much is sure.
But what about biomedical waste? Today you cannot save human lives without producing biomedical waste, and as a result, it tends to be overlooked and accepted as a necessary evil. If medical supplies were reduced to reduce waste, that would jeopardize human lives and would not be acceptable.
If only this waste were recycled correctly, it would not have been a problem. But recycling is costly, dumping in a landfill is cheap, and multi-million companies need to hold on to their millions, right?
Single-use items such as needles must be thrown away after one use, or they may transmit diseases between patients. They cannot be reused.
But in our (figurative) dive into biomedical waste, we came across a shocking phenomenon happening worldwide.
A very large number of people reuse lancets.
What is a lancet?
A lancet is simply a pointed piece of surgical steel, akin to a very small scalpel, that can be used to puncture your skin. They may be used for getting a blood sample from the thin blood vessels near your skin, poking abscesses to drain them, or testing for allergies.
Lancets come in different widths, known as “gauges.” A higher gauge means a narrower puncture in both lancets and needles, while a lower gauge means a thicker puncture. Thus a 27 gauge lancet is wider than a 30 gauge one. The choice of gauge depends on the requirement: a lower gauge may be more painful, while a higher gauge may fail to draw enough blood.
If you are someone who uses lancets, knowing your suitable gauge can make your life less painful.
What is a lancing device?
Lancets can be used manually, and many people do so. But a lancing device makes using a lancet much easier. It is a pen-like device with a spring mechanism that drives the lancet into your skin and then retracts it very quickly. It also has a depth control that makes sure that the lancet does not penetrate beyond a certain depth.
Lancet devices often come free with glucometers and can be bought reasonably cheaply. Using one can prevent unnecessary pain and the formation of calluses.
Lancet devices have a holder where a lancet can be loaded when needed and removed after use. Thus while lancets may be removed and thrown away, the device itself can be used multiple times. In fact, it can be in use until it stops working. However, it must be appropriately cleaned and sterilized after every use.
This brings us to a dilemma: the CDC and every medical professional will tell you that you must throw away lancets after a single-use. Yet hundreds of thousands of people reuse their lancets, some only changing when it gets too painful to use, without any instances of major infections.
To understand this, let’s look at the risks of reusing a lancet and then find out why so many people reuse them.
What are the risks associated with lancet reuse?
1. Infection:
Lancets work by penetrating your skin deep enough to reach the thin capillaries underneath. When you use a lancet, some blood usually soils the blade and other materials such as skin cells. And that is considering you properly wipe the fingerstick site using alcohol before every prick, which if you don’t, bacteria from the surface of your skin also contaminate the lancet blade.
The blood soiling the lancet coagulates over time and hardens. Even if you clean the lancet, you might miss some blood, which will give rise to bacteria on the blade that can enter your body when you reuse the lancet.
2. Cross-infection:
Suppose a lancet is reused between different individuals, for example, in an old age home. There is a very high risk of cross-infection and spreading of bloodborne diseases such as HIV and Hepatitis B. These are deadly diseases caused by viruses that can spread through the reuse of lancets or needles. Never reuse lancets between different individuals.
3. Blunting:
Lancets are designed to be used only once. When you use a lancet, the impact also damages the lancet itself while it breaks through your skin. The tip of the lancet gets blunter with every reuse. Every time you reuse your lancet, it has to hit a little harder to penetrate your skin. Over time this can lead to callus formation, which means you need even more force and depth to draw blood. It’s a cycle of pain.
Why do people reuse lancets?
Reusing may also cause your finger stick wound to fester, especially in diabetics, who also happen to be the biggest personal users of lancets. So if there are this many risks involved, why do so many people reuse lancets?
1. Costs:
If you are someone who checks their blood sugar 5 to 6 times a day, changing lancets after every prick means you will run out of lancets very fast. And if you need to check your blood sugar 5 to 6 times a day, chances are your medical expenses are high, and buying even cheaper supplies like lancets can become a burden.
Another factor is insurance. While insurance may cover most of your expenses, they are known to be very whimsical. Lancets and other home diagnostic instruments are often not covered by medical insurance. In cases where they are covered, the insurance provider will often specify a select number of brands.
So if you are more comfortable using, say, a different brand of glucometer, you will have to pay for the device and lancets yourself.
This is not limited to just lancets: the World Bank estimates that more than 11% of healthcare expenses in the US are out-of-pocket expenses. Such expenses often force patients to go for such practices as reusing lancets and insulin needles.
2. Lack of Evidence:
Even though the CDC explicitly prohibits the reuse of Single-Use Devices, any ER nurse that hears that you have been reusing lancets will probably give you the talk.
The reality is that most people who reuse lancets rarely face any problems. That is not to say that problems don’t happen – many who reuse end up with painful infections and even rotting fingers. But such instances are few and far between and often very mild.
This has led to a belief that it is okay to reuse a lancet a few times for the same person, and truth be told, there is too little evidence to outright refute that belief.
3. Wastage:
Changing lancets after every use produces a considerable amount of waste. When you find yourself producing so much waste in such a short time, you might start questioning yourself.
“Is it worth it to change lancets every time?”
“I am sending all this to the landfill.”
“If I just reuse it once, I can cut my waste to half.”
It all comes down to what you will get used to. Most people who need to regularly use lancets, such as diabetics, usually start off by changing lancets after every use. But as the months turn into years, changing every time seems too much of a hassle. As they start reusing and “nothing ever happens,” that is what they get used to.
Do’s and don’ts of lancet reuse
We do not condone reusing lancets or any other Single-Use Devices (SUDs). However, we realize that reality is far from ideal, and if you reuse your lancets, please follow these rules.
Never reuse lancets if:
- Someone else has used it before you.
- You have uncontrolled diabetes.
Healing is impaired in uncontrolled diabetes, and even a minor injury or infection can lead to dangerous and sometimes lethal consequences. It isn’t unheard of for a diabetic to step on a nail on a Saturday and end up in a hospital on Monday.
- You have trouble seeing clearly:
Vision problems might result from very high or uncontrolled blood sugar levels. High blood sugar can damage the retina, the part of the eye that acts like a film and receives the image from the lens, leading to diabetic retinopathy.
- You have trouble using your hands:
Similar to the retina, nerves, and nerve cells are also affected by prolonged high blood sugar. Some of the first signs of nerve damage are tingling, numbness, and shaking hands and fingertips.
- You have infections or open wounds:
Having an infection or an open wound may mean two things:
- There are pathogens in your body, and increasing the pathogen load by reusing a lancet is simply a bad idea.
- Your body is already fighting against infection, so your immune system is high alert. In such a situation, it may lead to increased inflammation on reusing a lancet.
Finally, if you do reuse lancets, you need to make sure that you:
- Wipe the finger stick site properly with alcohol before using the lancet.
- Clean the lancet properly after every use, ensuring there is no blood on the lancet.
- Properly recap the lancet after using it.
- Change pricking sites regularly to prevent callus formation.
- Visit a doctor if you think you have an infection in a fingerstick area.
Conclusion: To reuse or not to reuse?
While there is no easy answer to this, we can see that while reusing lancets reduces the costs of self-testing or healthcare for the average Joe, it comes with the risk of infection and trauma.
Maybe it did not happen to your uncle, who reused lancet all his life, but it may still happen to you. If this risk-to-cost relationship seems acceptable, you may reuse lancets.
However, since lancets often come free with the much costlier testing strips and are pretty cheap, why take such risks?
Bibliography:
What is the use? An international look at reuse of single-use medical devices – ScienceDirect
Implementing best phlebotomy practices – WHO Guidelines on Drawing Blood – NCBI Bookshelf
