first shift of preceptorship: told that my IV priming is wrong - page 4

The hospitals in this city use the Alaris pump and this kind of Alaris infusion set: Prior to my preceptorship, I've always twist that end cap a little bit so that the IV solution can dribble... Read More

  1. Visit  samadams8 profile page
    1
    Quote from pamelalayn
    It really doesn't matter either way. I am amused at your preceptor thinking she's "miss sterile". If it was you'd have a sterile field and sterile gloves etc. Washing your hands and putting on clean gloves, yes of course. But her thinking is ridiculous. If you are using your clean technique and always wearing gloves (also to protect yourself from the cancer causing agents possibly in the bag) and not touching the garbage with with the tip, you're fine. I think it's a great question and the other people commenting and acting nuts is crazy. I think it's very narrow minded of her to tell you that you are not not doing it right. I wonder what other things she will demand for you to do.

    Oh thank goodness you replied. I thought it was just me. Seems a bit silly to me too, and I have worked in NICU, where they try to be ultra careful with every little thing.

    After I've carefully primed, I carefully recap--making sure of course the cap was never contaminated on the inside.

    ???
    Sugarcoma likes this.
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  3. Visit  Sugarcoma profile page
    0
    samadams I wish I could do more than just like your post. Common sense....it really is not so common is it? lol.
  4. Visit  IVRUS profile page
    1
    But after removing a cap, you shouldn't recap with the same cap as caps are single use only. Once removed it should be pitched. There are reasons educators like to see things done in a certain way as it produces the best patient outcomes. Are there other ways of doing things.. sure.. but they may not be the safest for your patient. It is sad when one dismisses the expert advice of another when that person was just trying to help. I won't ever profess to be an expert in wound care, or OB-GYN, but Infusion Therapy is my specialty and the knowledge imparted is from years of study and researching outcomes. After all, shouldn't nurses help other nurses with their experience and knowledge...Yes, I think we should, however, it will only benefit someone if they have ears to hear.
    redhead_NURSE98! likes this.
  5. Visit  Pepper The Cat profile page
    5
    I can't believe the preceptor made a big issue out ot this; but this shows a lot of the ridiculousness in nursing.

    The OP is sweating the small stuff b/c the preceptor is being a control freak over this kind of thing.
    That's a little harsh. The preceptor corrected the OP. Part of being a preceptor. She told her once. That is not being a control freak.
    roser13, Altra, chevyv, and 2 others like this.
  6. Visit  hiddencatRN profile page
    3
    Quote from equestriRN
    We use the same tubing. There is no need to remove the end cap as it is "flow through". There is a chance, however small, of contamination if the end cap is removed or loosened - especially if, like me, that end hits things like the sink or garbage when I'm priming the line (particularly in a rapid response situation)
    Yeah, I was going to say this as well. I've never needed to mess with the cap until I connect it to the patient- you can prime it fully with the cap completely in place.

    OP, are you familiar with the phrase "when in Rome"? You are in Rome now. Do as the Romans do.
    Fiona59, chevyv, and KelRN215 like this.
  7. Visit  dudette10 profile page
    2
    Quote from IVRUS
    But after removing a cap, you shouldn't recap with the same cap as caps are single use only. Once removed it should be pitched.
    I have a question about this. In another long-dead thread, we all talked about using the saline flush caps to cap off a line of, let's say antibiotics, after they've infused. (Take cap off, being careful to not touch the sterile end, capping the end of the tubing, then flushing with aforementioned NS flush.) I understand "single use only" but what is the infection risk and where does it come from?
    psu_213 and wooh like this.
  8. Visit  wooh profile page
    1
    Quote from dudette10
    I understand "single use only" but what is the infection risk and where does it come from?
    This. If all the cap touches is air between being taken off the line and being put back on, WHERE does the infection risk come from? Because taking a new cap out of it's packaging, it's going to touch the same air between package and line as the cap touched between line and again line.
    I get that it says "single use only" but it's not like a spy message that the cap is going to self destruct after one use.

    Oh, and to those that think you don't have to remove the cap to prime, with some tubing you do have to take the cap off the end (or at least loosen it) to get the tubing to prime. Not true of all tubing, but the tubing we currently use requires it.
    redhead_NURSE98! likes this.
  9. Visit  hiddencatRN profile page
    0
    Quote from wooh
    This. If all the cap touches is air between being taken off the line and being put back on, WHERE does the infection risk come from? Because taking a new cap out of it's packaging, it's going to touch the same air between package and line as the cap touched between line and again line.I get that it says "single use only" but it's not like a spy message that the cap is going to self destruct after one use.Oh, and to those that think you don't have to remove the cap to prime, with some tubing you do have to take the cap off the end (or at least loosen it) to get the tubing to prime. Not true of all tubing, but the tubing we currently use requires it.
    OP is using Alaris pumps. I've never used Alaris tubing that requires the cap to come off.
  10. Visit  tokebi profile page
    1
    We use Alaris and I noticed that certain tubings will not dribble further with the cap on once the fluid reaches the end. So, if there is a big pocket of air, you'd have to open the cap.

    It's unfair to decide what is right way or wrong way, because each hospital looks at the evidence and decide what product to purchase and write their policy. A nurse from one institution will do differently from another nurse from somewhere else.

    Our unit has strict policy of capping the IV line with a single-use cap each and every time. Discouraging the re-cycling (or using the cap from your flush) is just an attempt at reducing the opportunities of contamination as much as possible. The outside surface of the saline flush or already-used cap is no longer sterile. By touching it and using it to cap your line, you're increasing the chance of the male end of the tubing to be contaminated. By opening a sterile package and using the fresh cap right there, there's less risk.
    samadams8 likes this.
  11. Visit  samadams8 profile page
    0
    Quote from Pepper The Cat
    That's a little harsh. The preceptor corrected the OP. Part of being a preceptor. She told her once. That is not being a control freak.
    To even make an issue out of this, from the "preceptor's" standpoint, is totally control freakish. Way TOO common in nursing.

    > than 20 years in this field. Seen it more times than I can count. I told OP to suck it up though; b/c too many "preceptors" are not able to consider that there are various ways to do things, and a lot of that has to do with the need to be in control.

    Lots of severe insecurity in nursing. It just is. Sad really.
    Last edit by samadams8 on Oct 16, '12
  12. Visit  samadams8 profile page
    0
    Quote from hiddencatRN
    Yeah, I was going to say this as well. I've never needed to mess with the cap until I connect it to the patient- you can prime it fully with the cap completely in place.

    OP, are you familiar with the phrase "when in Rome"? You are in Rome now. Do as the Romans do.

    As I said, sometimes it's fine other times it's not. The key is to get out air and maintain aseptic technique. This can be achieved both ways. You just need to be careful.


    Angels on the head of a pin.
  13. Visit  samadams8 profile page
    1
    Quote from tokebi
    We use Alaris and I noticed that certain tubings will not dribble further with the cap on once the fluid reaches the end. So, if there is a big pocket of air, you'd have to open the cap.

    It's unfair to decide what is right way or wrong way, because each hospital looks at the evidence and decide what product to purchase and write their policy. A nurse from one institution will do differently from another nurse from somewhere else.
    ^ This

    Quote from tokebi
    Our unit has strict policy of capping the IV line with a single-use cap each and every time. Discouraging the re-cycling (or using the cap from your flush) is just an attempt at reducing the opportunities of contamination as much as possible. The outside surface of the saline flush or already-used cap is no longer sterile. By touching it and using it to cap your line, you're increasing the chance of the male end of the tubing to be contaminated. By opening a sterile package and using the fresh cap right there, there's less risk.
    That's fine. It's just that you can do it without contaminating the inside of the cap that will touch the end of the line--or if you are hooking up to the line, you can do that.


    This is an easy solve for OP though, at least temporarily. Even though the preceptor is taking the hardnose road on this, just go a long with it for now. It will always be something. It could whether you should put on adhesive solution under a Stat-loc or something else. People argue about where to zero the line at the phebostatic axis--where the line in going right into the heart or with an imaginary line from the transducer to that proximity. It's always going to be something. You can try to you EBP, but the use or application of it will still vary.

    People need to keep in mind what the goal is for the particular procedure, and if it can be met in one way, another way, or multiple ways.

    Some nurses love the pizzing contests, so that they get to assert their dominance, or b/c they have gotten some rigid sense of things fixed in their minds. At the end of the day, job one is to do the best for the patient and to work together to achieve what is best.

    There's a certain finese with guiding and teaching people in the clinical setting. Some people have it , and some people don't. If it's that big of a deal, there ought to be a policy in place about it. Whipping out the policy is a shut up. . .until you have a problem with, say, priming--in which case what do you do? Well, you aspectically remove the cap without contaminating the inside of the cap, or as was mentioned, get a new one and have it read, proceed to carefully prime the line, attach or cap with non-contaminated cap or new non-contaminated cap. What is on the inside should not be contaminated--what will actually touch the line and place organisms potentially at the end where the sterile medicine/fluid will go into the line.

    BUT, seeing that probability will include interfacing with some percentage of those that don't have the right kind of insight and finese for teaching or precepting, the OP just needs to follow the policy as closely as possible. If not, she has to follow the preceptor's position unless it is something that is dangerous, which it is not.

    I have seen umpteen nurses show nurses that are being oriented/precepted how to do thus and such--all of them doing it somewhat differently and no policy in place. Often there isn't a policy, b/c it's not a matter of doing it exactly this way or that, but it is a matter of meeting certain goals--such as maintaining aseptic technique.

    Either way, I have seen these things needlessly become issues for those being "precepted." It's confusing and frustrating to them. If it's not standardized, the only thing the poor preceptee/orientee can do is do it differently with each "preceptor"--that is, doing it how each person that steps in to precept does it. So you could do it with Mary on Tuesday this way, but then be with Lucy on Thursday, and she does it that way. What a major pain in the arse.


    But really please don't tell me there isn't a control-freak element to making big issues over such things. I have been in the field way to long. I know better.

    Sounds a bit like the "preceptor" is making a sticking point out of this; but the only thing for the person being precepted is to smile and do it her way. On Thursday she will again have to do it Lucy's way if there is no clear, written policy.


    Something is wrong with people when they just can't learn to respect and work together with each other and keep the primary goals in mind. So many times in nursing, if you don't let the person that has some hand of control do it their way, you are put on the outs. It's ridiculous, and it's rather unhealthy.
    Last edit by samadams8 on Oct 16, '12
    catlvr likes this.
  14. Visit  netglow profile page
    5
    So the real question is.... (please fill in the blanks)


    How many nurses does it take to prime a line?

    One to __________, another to ___________, and 9,500 to ***** that the other
    2 have no idea what they are doing.

    (allnurses census at the time of this joke)
    Last edit by netglow on Oct 16, '12 : Reason: screwed up my own joke
    chevyv, libbyliberal, Sugarcoma, and 2 others like this.


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