A question about the use of drawing-up needles

[5alazar]

Hey everyone,

I just have a question with regards to (blunt) drawing-up needles.

So recently at a couple of hospitals I've worked at, they've begun changing the normal practice of drawing saline flushes up straight from the 10 ml ampoule to using a drawing-up needle to draw it up.

They cite infection control as a reason.

I've been struggling to find evidence to back this up in the literature.

I understand there MAY be an infection risk attaching the sterile syringe to part of the 10 ml ampoule that is exposed and unsterile, but I would like to find some kind of literature evidence to back it up.

Many thanks in advance!

[meanmaryjean, DNP, RN]

OP: I'm confused here. Are you actually talking about a vial with a rubber stopper? Because an ampule/ ampoule is a totally glass container which is broken to access the liquid medication inside. It requires the use of a filtering needle for safety.

[klone, MSN, RN]

Yes, need more clarification. Your last paragraph in particular confused me.

I don't understand how one would attach a syringe to an ampule (vial?) without some sort of needle.

[Atl-Murse]

You have to draw up NS flush ? I thought all hospital had the pre made flush now. Last time I saw a nurse draw up a NS flush was at a prison with 1960' s equipments

[smf0903]

You have to draw up NS flush ? I thought all hospital had the pre made flush now. Last time I saw a nurse draw up a NS flush was at a prison with 1960' s equipments

We just went to prefilled flushes at our hospital. And by "just" I mean like 3 weeks ago!

[blondy2061h, MSN, RN]

We just went to prefilled flushes at our hospital. And by "just" I mean like 3 weeks ago!

But the important thing is you now no longer draw up your own saline flushes! Is it a wonderful feeling?

Apparently when some of the nurses I work with first started they kept a litter bag of saline in the med room to draw up flushes from right next to a liter bag of potassium concentrate (?!) that they made k runners from. They had their fair share of errors. Scary to think about.

[smf0903]

But the important thing is you now no longer draw up your own saline flushes! Is it a wonderful feeling?

Apparently when some of the nurses I work with first started they kept a litter bag of saline in the med room to draw up flushes from right next to a liter bag of potassium concentrate (?!) that they made k runners from. They had their fair share of errors. Scary to think about.

Yes it is lovely! This was the first facility I've ever been in the used multi dose vials of NS to fill syringes for flushing. We used to only use prefilled for flushing central lines and such.

[Atl-Murse]

We just went to prefilled flushes at our hospital. And by "just" I mean like 3 weeks ago!

Sweet baby Jesus, I feel special and spoiled

[iluvivt, BSN, RN]

Just don't use your normal saline pre-fills to reconstitute ANY medications.They are for flushes only and you should be using normal saline from a vial to reconstitute medication or dilute medication.The Institute for Safe Medical Practice has a warning out this bad practice of using the pre-fills incorrectly.

[Julius Seizure]

Just don't use your normal saline pre-fills to reconstitute ANY medications.They are for flushes only and you should be using normal saline from a vial to reconstitute medication or dilute medication.The Institute for Safe Medical Practice has a warning out this bad practice of using the pre-fills incorrectly.

I assume that this is what you are talking about - correct me if I am wrong.

If so, then the warning is more to not use the saline-labeled syringes for medications. If you want to attach a needle to your saline flush and squirt it into a med vial for reconstitution, that's an okay use. There is nothing about the saline itself that is a danger. BUT you need to then draw the medication flush up into an unlabeled, appropriately sized syringe. Two reasons - proper labeling, and proper measurement markings on the syringe.

[kiszi, RN]

I assume that this is what you are talking about - correct me if I am wrong.

If so, then the warning is more to not use the saline-labeled syringes for medications. If you want to attach a needle to your saline flush and squirt it into a med vial for reconstitution, that's an okay use. There is nothing about the saline itself that is a danger. BUT you need to then draw the medication flush up into an unlabeled, appropriately sized syringe. Two reasons - proper labeling, and proper measurement markings on the syringe.

There is no harm in reconstituting a Protonix or other med at the bedside and giving it immediately. Changing syringes would serve no purpose.

I can see the reasoning when a med is reconstituted for later use, but even so, such a syringe should have an appropriate label added regardless. Why would it matter if it was a "normal saline" syringe or a plain one, if it was labeled?I

Meds mixed in a normal saline bag are kept in the original fluid bag, no?

[TriciaJ, RN]

Yes, need more clarification. Your last paragraph in particular confused me.

I don't understand how one would attach a syringe to an ampule (vial?) without some sort of needle.

Unless he means an access device placed in the multidose vial of saline. At a hospital where I worked the device was called a clave port. It was pushed through the rubber stopper and the syringe was attached and disconnected. It was deemed an infection control issue and the hospital went to predrawn individual saline flushes.

I think the OP's hospital must have realized the infection control error of their ways but are still using multidose vials. Am I correct, OP?