Double usage of saline flush? (flush and reconstitution of drugs)

[pineau]

Dear all,

I heard that somme practitioners were using prefilled syringes of saline to both flush but also sometimes to make reconstitutuion or dilution?

Is is something common in wards?

What is your opinion about this practice?

Regards

[iluvivt, BSN, RN]

NS pre-fills should NEVER be used to reconstitute medications. They are marketed ONLY has a flush. The ISMP has put out a warning about the dangers of this practice having to do with the potential for adding a drug to the pre-fill and the it being used as NS. Also there is a problem with sterility past a certain point in the syringe. I have the the newsletter at work and will see if I can post it.

[pineau]

It will be very interesting if you could post it!

Thanks for your answer

[iluvivt, BSN, RN]

OK I will find it..it was in the ISMP newsletter

[blondy2061h, MSN, RN]

I draw all my meds up in NS flushes and use it a lot of reconstituting things like IV Protonix, which is just supplied as powder in a vial in our Pyxis. I label everything the second I draw it up/mix it. I would also never use a flush that wasn't in it's outer wrapper.

[pineau]

If i understand what your are saying, you use prefilled saline flush for reconstitution. You take out little quantity of saline, aspire the drugs from a vial and then change the label of the saline syringe to warn that it no longer contains saline. Is that what you mean?

[blondy2061h, MSN, RN]

I inject the saline into the vial, mix the drug up, and draw it back into the flush syringe. I then put a sticker on the syringe labeling it with the drug and dose I added.

[KelRN215, BSN, RN]

What blondy describes is EXACTLY how we did it when I worked in the hospital. Said hospital only carried pre-filled NS syringes... it did not carry sterile water vials outside of the pharmacy nor did it carry normal saline vials. I always labeled the syringe the minute I added anything to it but I can't say that everyone did the same and the risk for error was definitely there.

[blondy2061h, MSN, RN]

but I can't say that everyone did the same and the risk for error was definitely there.

I've never seen a nurse I work with no label a syringe they added a drug to, but I would never use an unwrapped flush for this reason. I can't be responsible for my coworkers, but I can ensure that my practice is safe.

[mappers]

When I was in the hospital, we did have sterile vials of NS and water for reconstituting. I also used these to dilute drugs. I did not use flushes. Others did, but it was against policy. Now, I'm outpaitent and we have a pharmacy and they mix almost everything. We will mix Cath flow and we use sterile water for that out of a vial. If I have to dilute morphine or demerol or dilaudid or phenergan, I might use the flush or I might use a vial. It's rare that we have to do that, however.

[iluvivt, BSN, RN]

read this: Is It Really Saline

[iluvivt, BSN, RN]

The previous post describes a practice that is UNSAFE and should never be done. If you do not have NS in vials to use to reconstitute medications then you need to point out this newsletter and speak with a knowledgeable pharmacist. I too am working on this with pharmacy to prevent this form being done.