first shift of preceptorship: told that my IV priming is wrong - page 6

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,... Read More

  1. 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.

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  2. 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.
  3. 0
    If the manufacturer states that they are "single use" item, then using them on anything else is an off-label use and the manufacturer will NOT stand behind it. The ease in which an removed cap can become contaminated is great and therefore, once removed, discard. Best practice ensures better patient outcomes.
    BTW, this is not a SPY message either and therefore, will NOT self destruct after written. :-)
  4. 1
    Quote from IVRUS
    If the manufacturer states that they are "single use" item, then using them on anything else is an off-label use and the manufacturer will NOT stand behind it. The ease in which an removed cap can become contaminated is great and therefore, once removed, discard. Best practice ensures better patient outcomes.
    BTW, this is not a SPY message either and therefore, will NOT self destruct after written. :-)

    That's all fine. I am for it. What happens when it doesn't prime well w/ cap on? Again, the goal is to effectively prime the line while also maintaining aseptic technique. If that occurs with the cap still on, great! More more to the manufacturer! Seriously.

    It's just that effectively priming does not always occur this way. So, in such a case, maintain aseptic technique--which is something taught in schools and in clinical practice for a reason. When you are manipulating things that will go into a patient (non-enterally especially), you must THINK and be mindful of what you are doing through the whole process, even when you must troubleshoot.

    In critical care, you must troubleshoot a lot, b/c things do not always work or roll as nicely and neatly as presented in the best case scenarios. Murphy's Law is real often enough. So you have to maintain aseptic technique, while meeting the goals and dealing with Murphy's Law.

    On general principle, I'm cool with the manufacturer's recommendations, especially where they are evidence-based. But we have to be cognizant of what we are doing--the goal and maintaining aseptic technique. A sterile cap cover on a line has a high level of improbability of becoming an off-label court case. LOL

    Nurses must often improvise with materials used. This is nothing new. When you don't have to; fine! Saves time. Who is not down with that? The idea of teaching people certain principles is that if they have to troubleshoot, they are still keeping the core priniciples in mind--i.e., aseptic technique.

    We have primed pressure lines for years and have had to take the end caps off or change them or take them off again to continue priming the presssure lines--even with the little holes in at the end. You just couldn't get enough pressure flow sometimes to get all the air out of the system or around a transducer, etc. If you are careful in what you do, you will not contaminate the inside of the cap. Is there a chance of contamination? Yes! There is always a chance of contamination; hence the importance of teaching people about sterile/aseptic technique.

    This is a common sense kind of thing. If you can prime the thing with the cap on, great. If you can't, loosen it or take it off and be careful. If there is concern about contamination, get a sterile cap or sterile needle and cover the end of the thing to protect it until you are ready to use it for the pt.

    See the point is, I don't really care so long as you are meeting the goals of what you are trying to do--prime the line correctly and maintain sterile technique. This is not advanced theorhetical physics; but it is basic physics when air pockets are not effectively removed for a line.

    OK. It's been fun, but I can't imagine saying any more on this issue. It seems pretty straightforward to me. Troubleshooting is a big part of nursing skills. Things often enough don't work the way they are supposed to. This is why we have brains and are taught certain principles. Oy and vey. Otherwise OP, bite the bullet and get through orientation for God's sake.
    Last edit by samadams8 on Oct 17, '12
    Sugarcoma likes this.

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