Using same syringes all day - page 3

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   RN92
    I've got an idea - lets ask the patients if they would mind us using syringes over and over again. Explain to them - that there's only a small chance of cross contamination. Maybe we could also save the hospital money by reusing bedpans, urinals, foleys, etc...
    Would the hospital give them a rebate ? I'll bet that the hospital charged each and every patient for that same syringe. Also, reading this conversation about aspirating, amber ports, hepatitis, and how there is little chance of contamination - that would be to assume that we know all of the risks involved. There was a time when we had never heard of AIDS - I wonder what disease is lurking around the corner. You can never be too safe. Anyway, thats my two cents worth. :chuckle
  2. by   NeuroICURN
    Quote from jwk
    Propofol is a particular concern. It is supposed to be discarded after 4 hours due to propofol being an excellent bacterial growth media. There was a well-publicized case several years ago of an anesthetist who used the same propofol syringe for several days with less than favorable patient outcomes.
    Actually propofol (Diprivan) is good for 12 hours. After that, the bottle and the tubing must be replaced.

    As for reusing syringes, just the thought of it makes my skin crawl!!! Surely noone still does that today!!!
  3. by   RN92
    Quote from 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?
    Why not put it on your living will
    Last edit by ERslave on Jul 7, '04
  4. by   kittylvr
    Can we all say EWWW! hope I never have to have surgery with them.
  5. by   jwk
    Quote from NeuroICURN
    Actually propofol (Diprivan) is good for 12 hours. After that, the bottle and the tubing must be replaced.

    As for reusing syringes, just the thought of it makes my skin crawl!!! Surely noone still does that today!!!
    12 hours in the ICU when spiking the big vials directly for infusion - 6 hours when drawn up into a syringe, which is the norm in the OR.
  6. by   InterestedRN
    Quote from stevierae
    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.
    Sounds like you have many more issues that concern you. I appreciate your vigilance in the operating room and in your area of practice. I suggest you ask some of these questions to the providers when you see them happening. Again, it is not standard of care to re-use syringes or tubing or medications between patients. I do not see this happening, and have not seen this happen in any of the institutions that I work in or have worked in. It is certainly something that I would challenge if I did see it happen.

    I'm not going to get into the "needle" issue. It is a matter of preference, it's not a conspiracy.

    Thanks
    Interested
  7. by   stevierae
    Quote from InterestedRN
    Sounds like you have many more issues that concern you. I appreciate your vigilance in the operating room and in your area of practice. I suggest you ask some of these questions to the providers when you see them happening. Again, it is not standard of care to re-use syringes or tubing or medications between patients. I do not see this happening, and have not seen this happen in any of the institutions that I work in or have worked in. It is certainly something that I would challenge if I did see it happen.

    I'm not going to get into the "needle" issue. It is a matter of preference, it's not a conspiracy.

    Thanks
    Interested
    I agree it is a matter of preference--that's why I am defending it. As an OR nurse, I would find it a real pain to come to work one day and find out that all our individual non-safety needles had been replaced with safety needles--they really are not practical in an operating room, and, since we (either OR nurses or anesthesia providers) rarely give IM injections--rather, we are simply using needles to draw up meds, etiher while circulating, or for local on the field, while scrubbed--we have little chance of being stuck with a contaminated needle.

    I am simply concerned with the threat of being fined or shut down by OSHA for non-compliance--but, guess it's not really my concern--it's the facility's. As for me, I can start an IV with whatever is available, regardless of brand, safety or non-safety---I am no prima donna.

    I understand what is and is not standard of care, and that isn't why I brought the issue up here. Again, I brought it up because I was curious as to what people were seeing in other areas of the country, and to promote honest discussion. I've worked with both CRNAs and anesthesiologists all over the country; I have to say the CRNAs are more receptive to change than some of the
    anesthesiologists who trained in the '70s and '80s are. However, the younger anesthesiologists are pretty much by the book where safety in patient care is concerned, as are the younger CRNAs--however, that is not universal.

    Honestly, InterestedRN, I find your replies to me just a tad condescending. I can't understand why--these are interesting discussions, and I have been around a long time as an OR nurse and paid my dues. If you do a search of my posts over time, you might just find I am pretty knowledgeable! I am not sure if you are an anesthesia provider or not, but I have been practicing as an OR nurse since '81; before that I was a corpsman who trained during the Vietnam era. I have no reason to exaggerate or make up stories, as you seem to insinuate. Simply because you have not seen something doesn't mean it doesn't occur. Hopefully, as discussions like this take place more and more, some of the unsafe practices I have described (and, remember, it was not so long ago that no one considered them unsafe; some still don't) occur less and less until they no longer occur at all. But, change cannot occur unless issues are brought up and DISCUSSED.

    Remember this, as well--OR nurses go from room to room and work with a variety of anesthesia providers, sometimes for hours at a time. Unless you give extended breaks (other than for coffee and lunches) to your fellow anesthesia providers and are intimately familiar with their carts and their routines, you may not know WHAT your fellow anesthesia provider in your facility are doing--you can only speak with absolute certainty about your own practices.

    "Conspiracy--" where the heck did THAT come from? LOL!!
    Last edit by stevierae on Jul 8, '04
  8. by   InterestedRN
    Quote from stevierae
    I agree it is a matter of preference--that's why I am defending it. As an OR nurse, I would find it a real pain to come to work one day and find out that all our individual non-safety needles had been replaced with safety needles--they really are not practical in an operating room, and, since we (either OR nurses or anesthesia providers) rarely give IM injections--rather, we are simply using needles to draw up meds, etiher while circulating, or for local on the field, while scrubbed--we have little chance of being stuck with a contaminated needle.

    I am simply concerned with the threat of being fined or shut down by OSHA for non-compliance--but, guess it's not really my concern--it's the facility's. As for me, I can start an IV with whatever is available, regardless of brand, safety or non-safety---I am no prima donna.

    I understand what is and is not standard of care, and that isn't why I brought the issue up here. Again, I brought it up because I was curious as to what people were seeing in other areas of the country, and to promote honest discussion. I've worked with both CRNAs and anesthesiologists all over the country; I have to say the CRNAs are more receptive to change than some of the
    anesthesiologists who trained in the '70s and '80s are. However, the younger anesthesiologists are pretty much by the book where safety in patient care is concerned, as are the younger CRNAs--however, that is not universal.

    Honestly, InterestedRN, I find your replies to me just a tad condescending. I can't understand why--these are interesting discussions, and I have been around a long time as an OR nurse and paid my dues. If you do a search of my posts over time, you might just find I am pretty knowledgeable! I am not sure if you are an anesthesia provider or not, but I have been practicing as an OR nurse since '81; before that I was a corpsman who trained during the Vietnam era. I have no reason to exaggerate or make up stories, as you seem to insinuate. Simply because you have not seen something doesn't mean it doesn't occur. Hopefully, as discussions like this take place more and more, some of the unsafe practices I have described (and, remember, it was not so long ago that no one considered them unsafe; some still don't) occur less and less until they no longer occur at all. But, change cannot occur unless issues are brought up and DISCUSSED.

    Remember this, as well--OR nurses go from room to room and work with a variety of anesthesia providers, sometimes for hours at a time. Unless you give extended breaks (other than for coffee and lunches) to your fellow anesthesia providers and are intimately familiar with their carts and their routines, you may not know WHAT your fellow anesthesia provider in your facility are doing--you can only speak with absolute certainty about your own practices.

    "Conspiracy--" where the heck did THAT come from? LOL!!
    I guess it is all in the way we read each others comments. Perceptions are not always accurate. I respect your experience and background, and condescention was never my intent. Yes, I am an anesthesia provider. Thanks for the conversation.

    Interested
  9. by   deepz
    Quote from stevierae
    ..... the unsafe practices I have described (and, remember, it was not so long ago that no one considered them unsafe......

    Please! No one? A bit of a broad indictment there, SR (Vaughan? Texas Flood, etc?). Many of us viewed reusing the same syringe as unsafe long ago; what is recent is the universal condemnation of such sloppy technics. As should be.

    deepz
  10. by   stevierae
    Quote from deepz
    Please! No one? A bit of a broad indictment there, SR (Vaughan? Texas Flood, etc?). Many of us viewed reusing the same syringe as unsafe long ago; what is recent is the universal condemnation of such sloppy technics. As should be.

    deepz
    Bad choice of words I used. What I meant to say was, and as prmenrs and jwk pointed out, in the '70s and '80s it was common practice. If you read post # 9, it is a note that an anesthesiologist colleague wrote to me, (copied in its entirety there) reminicing about those "old days" and how times and practices have changed for the better. He and I both remember when people drew up their pentothal in the a.m. from a common source, and he said he remembers one of his most respected anesthesia professors having syringes in his cart that were a year old or more.


    Lots of people didn't approve of it in the '70s and '80s--including myself and most of the OR nurses I worked with during those years--but it was still common practice, and we had no say in the matter. Now, the practice is gradually disappearing--finally.

    Ah, Stevie Ray Vaughn and Double Trouble--boy, could they sing and play the blues --may Stevie rest in peace.
    Last edit by stevierae on Jul 9, '04
  11. by   austinrobi
    Oops....(that's in case this is a repost: My 'puter burped just before I hit "send.")

    http://www.lasvegassun.com/news/2008...t-critics-say/

    This current case is very sad, and does not bode well for any one involved.

    Does anyone know just WHEN the universal precautions took effect?
    It is tragic that this lesson hasn't been learned yet.
  12. by   Rioplatense
    I'm glad you revived this thread from 3-4 years ago!! It's sad that ANYONE would cut corners and jeopardize patient safety to line the pockets of their employer. Today on our Nevada Public Radio, the discussion about this incident and its legal ramification included two class action lawyers. One was agruing that this happened because the anesthesia was given by nurses, not anesthesiologists. He said that they have a bad track record and that they are easily pressured by MDs. I tried calling in to refute that argument, cause there have been recent cases in NY state of MDAs doing the same thing, it has nothing to do with training, we all are trained and taught to know this is not good practice. Whether we follow through is a matter of concern for patient safety. It all still applies.
  13. by   jspacegirl
    I'm not an anesthesia provider, just a nursing student (who is looking into going to CRNA school someday), and I find this discussion interesting. I have noticed several nurses on the floor who reuse those pre-filled saline syringes to flush IVs. For example, if they don't use all of the solution in the syringe, they recap it and put it in their pocket to use for another patient. Or they leave it in the patient's room to use again on the same patient. I feel like an idiot for not realizing at the time that this was not safe or best practice. Thanks to the OP for bringing this up, and I'm glad I could learn something today.

    The practice of reusing syringes doesn't make sense to me anyway, because it's not as if the money is coming out of the nurse's pocket by using a new syringe!

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