Using same syringes all day - page 2

OK, I have wondered about this for many years, and wonder what the current thinking is. Wherever I have worked as an OR nurse, since the early '80s, anesthesia draws up their meds in the... Read More

  1. by   jwk
    Quote from InterestedRN
    I think that it is interesting that you would suggest that every anesthesia provider would engage in this practice. It is true that recently ONE practitioner was doing this, which contributed to a hepatitis infection spread. I'm a bit concerned about what your intentions are, and believe that your characterizations are exaggerated.
    I don't think EVERY anesthesia provider does this, and I'll bet almost none do it now. That being said, I can tell you it was very common 20+ years ago in many facilities around the country.
  2. by   keermie
    Quote from Fergie
    Just in the last year in Fremont, Ne an oncology clinic was using the same syringes. The Dr. left the United States and has charges pending. I understand the RN has lost her liscense. Many outbreaks of hepatitis and some deaths directly related to this. Why risk using the same syringe all day? If it was your loved one how would you feel about the syringe not being changed? We as nurses have the control and have a responsibility to make certain we are doing all we can as humans and professionals to prevent and spread of pathogens.


    The hepatitis outbreak (100 and counting) was the result of using a liter bag of fluid to draw flushes. The reuse of syringes or tubing or needles is indefensible because the CDC and OSHA specifically disband this practice. The best rational not to reuse syringes is that technically a syringe is not sterile once the plunger is depressed. Look at the packaging, they all read single use only.
  3. by   RNBSN1
    These people should be in jail. Years ago, I had a DON that actually encouraged reusing needles.
  4. by   explorer
    Quote from TejasDoc
    Check out some of these links, interesting stuff out there.

    http://www.asahq.org/Newsletters/2002/12_02/greene.html

    http://www.aana.com/press/2002/111302.asp

    http://www.aegis.com/news/ads/2003/AD032201.html

    http://www.news-star.com/stories/120802/hea_14.shtml

    I think there's more out there, but this is a good start for anyone who'd be interested. Science, human interest, we've got it all. Enjoy.

    TD
    Thank you for the links.
  5. by   jwk
    Quote from RNBSN1
    These people should be in jail. Years ago, I had a DON that actually encouraged reusing needles.
    25-30 years ago, there was no AIDS to worry about. Hepatitis was around, but wasn't thought to be a big concern. I know some old ENT surgeons who did tonsillectomies without gloves their entire careers (sterile or otherwise). There was no concept of "universal precautions". I don't know any anesthetists who routinely wore gloves for anything. Gloves for starting IV's? Nope. It just simply was not the way things were back then.

    I'm not excusing the behavior, at least as far as reusing syringes - it was wrong then as it is now. I'm just trying to provide a little historical background to the mindset back then.
  6. by   RNBSN1
    Quote from jwk
    25-30 years ago, there was no AIDS to worry about. Hepatitis was around, but wasn't thought to be a big concern. I know some old ENT surgeons who did tonsillectomies without gloves their entire careers (sterile or otherwise). There was no concept of "universal precautions". I don't know any anesthetists who routinely wore gloves for anything. Gloves for starting IV's? Nope. It just simply was not the way things were back then.

    I'm not excusing the behavior, at least as far as reusing syringes - it was wrong then as it is now. I'm just trying to provide a little historical background to the mindset back then.

    The year that I'm referencing is 1987-AIDS was prevalent then.
  7. by   kmchugh
    OK, let me add to the question. Once upon a time, within the last couple of years, I had a co-worker who would draw up a 20cc syringe of propofol for use with endo MAC procedures. This co-worker would put the syringe in a pump, connect tubing from the syringe to the patient's flowing IV line, and let 'er rip. When finished with one procedure, the co-worker would disconnect the tubing and throw it out, then attach a new tubing to the same syringe and use it for the next patient. I talked to this person about it a few times, but they felt the procedure they were following was safe, and saving the hospital money, since the procedures often only took 5 minutes. To this person's thinking, one syringe and one 20cc bottle of propofol could be used for two or even three patients.

    Clearly, I think this is wrong as two left shoes, but my co-worker could not be convinced. Any thoughts?

    Kevin McHugh
  8. by   WntrMute2
    Quote from kmchugh
    OK, let me add to the question. Once upon a time, within the last couple of years, I had a co-worker who would draw up a 20cc syringe of propofol for use with endo MAC procedures. This co-worker would put the syringe in a pump, connect tubing from the syringe to the patient's flowing IV line, and let 'er rip. When finished with one procedure, the co-worker would disconnect the tubing and throw it out, then attach a new tubing to the same syringe and use it for the next patient. I talked to this person about it a few times, but they felt the procedure they were following was safe, and saving the hospital money, since the procedures often only took 5 minutes. To this person's thinking, one syringe and one 20cc bottle of propofol could be used for two or even three patients.

    Clearly, I think this is wrong as two left shoes, but my co-worker could not be convinced. Any thoughts?

    Kevin McHugh
    I too hava a coworker that does the same thing. Poor practice I believe.
  9. by   stevierae
    Quote from InterestedRN
    I think that it is interesting that you would suggest that every anesthesia provider would engage in this practice. It is true that recently ONE practitioner was doing this, which contributed to a hepatitis infection spread. I'm a bit concerned about what your intentions are, and believe that your characterizations are exaggerated.
    Huh?! What? I think maybe you misunderstood my post, and I certainly have no secondary agenda! Nowhere did I say or insinuate that "every" anesthesia provider I work with in today's environment (I do registry and travel OR nursing, as well as IV and pump teaching, in many states) did this.

    I think if you reread my original post you will understand. I was referencing the 80's, and even part of the '90s, when it was very common--not as common as in the '80s, but fairly common. I am unaware of any hospital acquired infections from these practices at any facility where I have worked or taught--that's not to say they didn't occur. I was not aware of the referenced hepatitis outbreak until I read about it here.

    Now, flash forward to the 21st century. I still see it done. Not consistently; not by everyone, but I still see it done. The borrowing of a succs drip (to be returned and used on various patients until empty) is one I have seen done, oh, as recently as the time I posted my original question.

    Oh, and putting extension tubing from a propofol syringe pump onto a patient's IV, then just discarding the extension tubing after use and using new extension tubing, but the same propofol with the same syringe pump tubing? Or not using extension tubing, but just changing the syringe pump tubing between patients? Still see that fairly frequently. Again--not by "every" anesthesia provider, and not universally. But--frequently enough to wonder where people are getting the idea that it is STILL acceptable.

    But, I posted to get opinions as to what other folks thought of what I was witnessing, and if they were still seeing it, too. I haven't posted to or read this thread in a while, so was surprised to see your comment. Mostly I was just interested in how other facilities do things, and their rationales for doing them that way.

    If you are looking for secondary agendas, InterestedRN, you won't find them in anything I post. LOL!

    OK, here is another question--do any of your facilities wash and reuse circuit tubing? I sometimes work at a place that still does--I know they did all throughout the '90s, when I was staff there; and when I work there occasionally now through registry, now, I still see it done. Is this type of recycling OK in today's environment, with SARS and community acquired pneumonia? The rationale I heard in the '90s was that there is one way valve on the tubing, so it all goes to the patient, therefore nothing (i.e., waste anesthetic gases) is expired that would "contaminate" the tubing....what say you all?
    Last edit by stevierae on Jul 7, '04
  10. by   prmenrs
    Kevin, you are absolutely right! Tejas had some good references. At some point in time, trying to convince someone to change their practice, no matter how outdated, becomes unproductive. TPTB need to write a policy stating the correct practice, and the disciplinary consequences of not following that policy clearly spelled out. After that, your co-worker is out on a limb from which I would not want to hang.
  11. by   InterestedRN
    Quote from stevierae
    Huh?! What? I think maybe you misunderstood my post, and I certainly have no secondary agenda! Nowhere did I say or insinuate that "every" anesthesia provider I work with in today's environment (I do registry and travel OR nursing, as well as IV and pump teaching, in many states.)

    I think if you reread my original post you will understand. I was referencing the 80's, and even part of the '90s, when it was very common--not as common as in the '80s, but fairly common. I am unaware of any hospital acquired infections from these practices at any facility where I have worked or taught--that's not to say they didn't occur. I was not aware of the referenced hepatitis outbreak until I read about it here.

    Now, flash forward to the 21st century. I still see it done. Not consistently; not by everyone, but I still see it done. The borrowing of a succs drip (to be returned and used on various patients until empty) is one I have seen done, oh, as recently as the time I posted my original question.

    Oh, and putting extension tubing from a propofol syringe pump onto a patient's IV, then just discarding the extension tubing after use and using new extension tubing, but the same propofol with the same syringe pump tubing? Or not using extension tubing, but just changing the syringe pump tubing between patients? Still see that fairly frequently. Again--not by "every" anesthesia provider, and not universally. But--frequently enough to wonder where people are getting the idea that it is STILL acceptable.

    But, I posted to get opinions as to what other folks thought of what I was witnessing, and if they were still seeing it, too. I haven't posted to or read this thread in a while, so was surprised to see your comment. Mostly I was just interested in how other facilities do things, and their rationales for doing them that way.

    If you are looking for secondary agendas, InterestedRN, you won't find them in anything I post. LOL!

    OK, here is another question--do any of your facilities wash and reuse circuit tubing? I sometimes work at a place that still does--I know they did all throughout the '90s, when I was staff there; and when I work there occasionally now through registry, now, I still see it done. Is this type of recycling OK in today's environment, with SARS and community acquired pneumonia? The rationale I heard in the '90s was that there is one way valve on the tubing, so it all goes to the patient, therefore nothing (i.e., waste anesthetic gases) is expired that would "contaminate" the tubing....what say you all?
    Thank you for clarifying your experience and position. What you describe is clearly sub-standard care and should not be acceptable practice in ANY health care providers approach to patients. Hopefully, your question will raise awareness, and (further) prevent this from happening.

    Let's face it, the only ones that are going to stop this kind of thing from happening are US.

    Thanks again,
    Interested
  12. by   stevierae
    Quote from InterestedRN
    Thank you for clarifying your experience and position. What you describe is clearly sub-standard care and should not be acceptable practice in ANY health care providers approach to patients. Hopefully, your question will raise awareness, and (further) prevent this from happening.

    Let's face it, the only ones that are going to stop this kind of thing from happening are US.

    Thanks again,
    Interested
    Yes, but--in every operating room in which I have worked or taught, the anesthesia department is a separate entity which makes its own rules, and is not interested, for the most part, in the input of the operating room nurses on subjects such as this. Not to say they don't respect us as professionals or value our input on other things; not to say they are not perfectly pleasant and sociable individuals--it's just on this subjects such as this, they make their own policies and procedures.

    I found this to be particularly true when teaching safety IV catheters, both for B Braun and for BD (Becton Dickinson--) even though I would teach how the safety IV catheters could be used as an art line (some anesthesia providers are skeptical, but it can be done) many anesthesia departments DID NOT want to use safety IV catheters. They were more comfortable with the old style non-safety catheters (i.e., InSyte vs. InSyte AutoGuard, the BD product which has the push button to release the stylet.) Heck, so were we--so was I--but the learning curve involves, perhaps, 3 sticks--after that, you don't even think about it any more.

    Also, even though the safer IV products were mandated by a bill signed into effect by then President Clinton, and hospitals could be fined for not using the safer products, for some reason the anesthesia department was always exempted. This included the last facility where I worked per diem. Our supervisor didn't like it, but she said that as long as the products were IN STOCK-- that is, AVAILABLE--they were in compliance, so who knows. However, she would have preferred that they switch, but was powerless in requiring that they do so---it was not her call.

    I do understand why other safety needles--i.e,. TB and insulin syringes with self-capping and pre-attached needles, or individual self-capping needles--are impractical and useless in an operating room, where most of our injections are IV through needleless ports, so that's never been an issue to argue about, in my opinion.

    We still need to keep the old, non-safety injection needles in the OR, not replace those with safety needles. When we draw up meds, we need non-safety 18 g needles to do it with. (Although, with multi-access vials, you can insert a spike adapter and draw through an empty syringe--but, then if you want to prepare a piggyback or just add medication to a bag of IV fluid for decanting onto the sterile filed, you STILL need an 18 G needle--so we need to keep the non-safety ones for tasks like this.
    Last edit by stevierae on Jul 7, '04
  13. by   Hellllllo Nurse
    Wow. I have no OR experience. When the time comes that my husband or I must undergo a surgical procedure, how should I go about letting the anesthsia staff know that I want to make sure only new, unused syringes and tubing are used for our care?

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