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 (http://static.medshop.com.au/images/...ula_303369.jpg
) 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.
Oct 14, '12
by CASTLEGATES, RN
Potential is there for fluid, regardless how it "appears to be" flowing, to be nonsterile if it's touching an outside environment. If you were mixing and creating an IV bag or drug under a hood, those are the types of rules they follow. Microscopically, you could theoretically find swirling within the drops of solution from the outside exposed to bacteria cap and the unexposed sterile fluid inside, so allowing it to flow with minimal disturbance (optimally not allowing it to drip at all) seems to be the best practice. If you sit back and look at it as if under a microscope and recognize what happened to our petri dishes when we removed the cover for 15 seconds, recovered and incubated, your preceptor has a point. Even the most sterile environments get seeded with a single bacteria, mold or virus. One cannot be too careful when there's a life at stake and there's absolutely nothing to lose by adding that extra care taking step. Just my two cents, but I'd learn why (exactly why) and definitely follow the hand of experience (and always, evidence based practice). Fluid transfers impurities, wherever the fluid is touching at a single moment is considered to have transfer and the outside of a sterile cap is exposed and potentially colonized by air drift or a brush of a hand, finger or dust (I'm not there to see, but I assume this is your preceptor's point and to that I agree). If it were my body, I'd want someone THAT careful hooking up my IV. Placing dirty fingers on a priming cap will definitely result in wet, transferrable contact from where your fingers were to the inside of the tube if viewed under microscope all that water swirrling (water never takes a direct route under magnification).
Last edit by CASTLEGATES on Oct 14, '12