TB Training

March 15, 2016

Hey friends,

So it seems like a lot of you like hearing about my clinical/hands on experiences. Well today I got TB certified so I thought I would briefly go over what that was like.

So first off, TB is a potentially harmful bacterial infectious disease that mainly targets the lungs. TB is spread through the air, which is why healthcare workers wear a specialized fitted mask (which we were never trained on in nursing school).  According to Mayo Clinic, TB is rare. There are fewer than 200,000 US cases per year.

A tuberculin skin test (Mantoux tuberculin test) is done to see if you have ever been exposed to tuberculin bacteria. The test is done by putting a small wheel (about 6mm) of TB protein under the top layer of your skin (intradermal). Your skin will react with the protein creating a firm bump (looks sort of like a bug bite) at the site within 2 days. Now, there are ways to have a false-positive. If the test comes back positive, then you will be referred for a chest x-ray. 

Now that is sort of the brief run down of TB. For my class today, we learned how to read TB skin tests on a fake arm. There are different specifications for a routine test versus someone who has HIV or been exposed to TB. In California, greater than or equal to 10mm is positive for someone who has been exposed to HIV, had an organ transplant, or has HIV. On the other hand, a routine test is greater than or equal to 15mm. Of course, if you have a positive TB skin test, you must get a chest x-ray. A TB skin is not the only indicator of a direct diagnosis. 

The second part of the class is where we actually learned how to insert the protein. We actually used normal saline for this process and my classmates all said that it stings. I wish I had pictures from the whole process, but you basically pull the skin tightly, after all preparation, about 4 fingers below the bend of your elbow and insert the bevel of the needle under the first layer of skin and inject. The tricky part was staying that thin under the skin. I highly recommend pulling the skin tight. 

The first time I placed one on a classmate, I went too deep and left her with a bruise. She was a trooper though. I was able to successfully place two on another classmate, which was all I needed to pass  my competencies. It always amazed me how little I practice items in nursing school before performing the skill. Luckily, we have a TB clinic coming up where we administer them for the freshman, sophomores, and juniors in the nursing program.

Like anything in nursing, practice makes perfect. And it is okay to not always exceed at everything. You can always tell the patient, "For your safety, I am going to get another nurse to place this test". 

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