Pre-filled saline syringes and checking central line blood return - page 2

by greenterra 9,440 Views | 16 Comments

Elsewhere on allnurses.com, a poster pointed out that one of the reasons why nurses shouldn't use prefilled normal saline syringes for diluting IV medications was that, in many cases, only the saline and interior of the syringe... Read More


  1. 0
    Quote from RazorbackRN
    Why would they need to make them completely sterile? Unless you are needing the exterior of the syringe to be sterile, then it doesn't make sense and surely wouldn't be cost effecient. I would think it would be better to just draw up your saline from the sterile vial in a sterile syringe for the instances when you needs a sterile exterior.
    You make a good point, then of course that entails dropping the syringe onto a sterile field giving you time to put on your sterile gloves to maintain sterility of the outside of the syringe. I can't see that happening on a regular basis outside of surgery, or the for the syringes which come in the setup kits for certain procedures done on the floors.
  2. 1
    Quote from RazorbackRN
    Why would they need to make them completely sterile? Unless you are needing the exterior of the syringe to be sterile.
    Well, if you are aspirating to verify the central line is correctly placed, you are bringing the sterile saline in the syringe back over an area of the barrel interior which was just below the non-sterile plunger, and been next to the non-sterile end of the rubber stopper.

    Typically one would then continue to flush with the same syringe to clear the central line of blood, but this might not be advisable with a non-sterile flush, as discussed above.

    Is this a theoretical problem or a practical problem?
    3rdcareerRN likes this.
  3. 0
    Quote from lpnflorida
    You make a good point, then of course that entails dropping the syringe onto a sterile field giving you time to put on your sterile gloves to maintain sterility of the outside of the syringe. I can't see that happening on a regular basis outside of surgery, or the for the syringes which come in the setup kits for certain procedures done on the floors.

    You are correct. I bet it doesn't happen much.

    I think the point here is, you maintain the most sterile enviroment that you can. I firmly believe that nothing is 100% sterile. Once it has been exposed to air, (regadless of negative pressure, etc), some microorganisms
    will contaminate the surface.
  4. 2
    This issue came up for us many years ago when these syringes became popular. The one way in which it did change my practice was when I was accessing ports. I used to be able to draw up the saline flush from a vial with one hand ungloved and the sterile gloved hand holding the sterile syringe and then set the syringe back onto my field and then apply my second sterile glove. Now I have to scoot the extension tubing while in the package to the edge of the wrapper and only pick up the sterile gripper when I am ready to access. We also make sure we do not place them on any sterile field as when in placing a midline,PICC or CVC as only the fluid and fluid pathway is sterile. I can assure there is no contraindication in using the pre-fills with and VAD. The risk of using using vials,other than for one time use poses a much greater risk for CVC-related infections and bloodstream infections.
    3rdcareerRN and RazorbackRN like this.
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    I think I understand. Original post is asking about sterility of the inside of the barrel when the part you use to push the med in (the "stem" of plunger. . .?) is touched? in clinical lab we were told NEVER TOUCH THAT PART because if you are drawing a med which requires you to pull back and then you push the med, the "contaminated" stem goes back into the barrel area, and if you had to push and draw a couple of times to get med ready, then you could contaminate.

    However, once in the real world I learned this was ridiculous and nobody had ever heard of that (ah, clinical skills lab!). A nurse could not function if that were true!

    Small note about mixing meds in prefilled syringe. . .
    I personally use one of our provided empty syringes to draw the med, and then draw from NS from the prefilled into the other syringe if I need dilution. I do this so when I walk into the room the syringe with the med in it LOOKS DIFFERENT than my flushes. Some meds I would NOT want to accidentally forget and push like a flush. I use a sharpy and label my syringe too, but I like things to be as different looking as possible! Maybe it's "new nurse paranoia", but it makes me feel better
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    Yes, in an ideal world nurses would be able to maintain aseptic technique in the midst of poo. As a final note, some facilities do prohibit aspiration using pre-filled flushes, though it isn't clear whether aspiration is OK if there is some injection prior to the aspiration, so the plunger is never pulled back beyond it's original "sterile manufactured" position. For example, here is an exchange from http://www.apic.org/source/Communiti...icId=20259#Top

    Non-sterile pre-filled flush syringes
    Manufacturer of these syringes does not recommend using them if plunger will be pulled back (as in aspirating for blood return)before injecting as they are not packaged sterily and, therefore, the "back end" of the syringe barrel is not sterile and, thus, the contents may become contaminated upon aspirating. Argument is being given by some nursing folks that once a regular syringe is removed from packaging and handled to draw up hep/saline flush, that syringe is also not sterile.

    Has anyone addressed this issue in your facility, and what was the outcome?

    Katherine R. Stauffer, RN, CIC
    ICP
    Shandsat AGH
    352.338.2121 ext. 3609
    Gainesville, FL

    Non-sterile pre-filled flush syringes (02)
    We were taught in nursing school techniques so as to not touch the plunger when drawing up medications.

    Sue Chen
    Infection Control Specialist
    California Dept of Health Services
    Richmond, CA

    I emailed Ms. Stauffer, and she OK'd my reprint of the above, and answered my query about whether they had come to a final conclusion about aspirating with flushes. She said:

    Based on dialogue with the manufacturer, our decision was to use the syringes only when it is not necessary to aspirate, and definitely not to mix a med in a syringe -- i.e., when the plunger would be pulled back into the non-sterile pathway.

    Kay Stauffer, RN, CIC

    I don't know if this thread helps anyone or merely muddies the waters, but thanks so much for the information that everyone has given!

    Greg
    3rdcareerRN and lpnflorida like this.
  7. 0
    I am a clinical specialist with one of the major manufacturers of the Pre-Filled Saline Syringes. These PF syringes are NOT sterile, only "clean". However, once you remove them from the wrapper, they are no longer clean, you just touched them with your hand. This includes the plunger which does in fact enter the syringe when depressing it and pulling back causes any flora on the plunger to be introduced into the sterile saline and any medication you may have diluted with the saline. PF syringes are to be used for FLUSHING ONLY.

    ***NO vascular access device should EVER be aspirated for blood return except a Central Line. The purpose of Positive Pressure flushing is to maintain line patency, aspirating blood causes blood to pool in the VAD reservoir, resulting in a clot, resulting in occluded VAD.

    BTW, this practice of "aspirating" also holds true for those of you that were inadvertently taught to inject air into a vial prior to withdrawing the medication. When you pull back the plunger of a syringe, you are introducing airborne bacterial flora into the syringe. There is no evidence that vials require air to withdraw medication.


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