Using same syringes all day

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 a.m.--their succs, their vec, their roc, diprivan, fentanyl, Versed, etc--and uses the same syringes all day long from patient to patient.

This was true in the '80s when we used Pentothal and when we still utilized the amber IV ports that required needle access. They also used the same needles all day--just stuck the needle, full or partway full syringe attatched, back into the multidose vials between uses. We usually put a stopcock on for the Pentothal and the succs; nowadays, of course, the tubing comes in with a built in dual stopcock for the Diprivan and the succs, and the other meds if desired, or they are infused through other ports, which are now needleless.

Also, if they prepared a succs drip in the morning, they used it all day long, from patient to patient. I can even remember other anesthesia providers popping their heads in and saying, "Can I borrow your succs drip?" and using it on THEIR patient, rather than preparing a new one.

My question is, is this practice considered acceptable nowadays? Should it even have been considered acceptable then? In today's litigious society, it seems that that is a lawsuit waiting to happen.

I can understand the rationale, I think--since they are injecting directly into a port, and not aspirating, (they also are not aspirating from the vial; just drawing up the medication directly) there is little likelihood of contaminating the syringe of medication with a blood borne pathogen such as HIV or Hepatitis--or, is there? What if there WAS a microscopic bit of blood in the tubing that backed up into the port or stopcock, perhaps not visible as a droplet of blood but enough to contaminate the syringe containing the medication (i.e., the succs) with Hepatitis? And thus, potentially, spreading it from patient to patient?

Same thing with the drip--it is being plugged directly into a port, and the likelihood of blood flowing back into that port to contaminate the tubing (which will be reused) is minimal--or, is it? Seems to me that ANY possibility, however remote, is too much of a risk to take.

I have always worked at institutions affiliated with prestigious medical schools and anesthesia programs, so I have thought, well, if THEY do it, it must be accepted practice--but then again, you would NEVER see such a practice by an RN in the ER or the ICU--i.e., using the same Dopamine or Lidocaine drip over and over, rather than wasting it; or using a full syringe, say, of Dilantin for multi patient use until it is exhausted . Are we as RNs overly cautious, or are the anesthesia providers I have described overly reckless? These are outstanding anesthesiologists and CRNAs I am describing here and ones that are passionate about optimal patient care, so obviously they consider the practice a low or no risk one.

Thank you one and all for your thoughts.

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.

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.

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

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.