First shift of preceptorship: told that my IV priming is wrong

[seks]

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 out while priming.

However, during my first shift of my preceptorship, my preceptor didn't agree with my method. She said just to let the IV solution flow to just before the end of the line, put in a threaded cannula and then let the solution dribble out. She mentioned that my method would cause the end to be non-sterile?????

Can someone shed some light on this as my previous clinical instructors have seen me prime IV lines and they never had a hissy fit about the way I do it.

[AheleneRN]

seks said:

So are you all saying my past clinical instructors are incompetent and don't know what they were thinking?So who is right or wrong or too anal or giving unecessary steps in this situation? My current preceptor or my past clinical instructors/buddy nurses?That is my MAIN question.It really is frustrating when you get different opinions on a technique and I don't know who to believe or abide by. Guess that is part of the so-called "reality shock"

For goodness sake, do it the way your preceptor says. Your clinical instructors are not the ones signing off on your orientation. Your preceptor is in charge not your clinical instructors. When you were in school, you learned according to how your clinical instructors taught you. BUT you are no longer in school so why would you go against the person that could make a difference between staying employed after your orientation or back to looking in the classifieds?! Do it his/her way and then develop your own way once you're done and have your own patients. Just my two cents. Good luck to you...

[tara1961]

u need to take perceptor's advise and believe me the next will tell u different, roll with this small thing or u will find yourself going crazy

[pamelalayn]

seks said:

Can someone shed some light on this as my previous clinical instructors have seen me prime IV lines and they never had a hissy fit about the way I do it.

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.

[Guest343211]

pamelalayn said:

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, RN]

samadams I wish I could do more than just like your post. Common sense....it really is not so common is it? lol.

[IVRUS, BSN, RN]

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.

[Pepper The Cat, BSN, RN]

Quote

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.

[hiddencatRN, BSN, RN]

equestriRN said:

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.

[dudette10, MSN, RN]

IVRUS said:

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?

[wooh, BSN, RN]

dudette10 said:

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.

[hiddencatRN, BSN, RN]

wooh said:

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.

[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.

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.