TriciaJ, RN 4,296 Posts Specializes in Psych, Corrections, Med-Surg, Ambulatory. Has 42 years experience. Sep 24, 2016 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.That is good to know. I had no idea. Thank you.
Julius Seizure 1 Article; 2,282 Posts Specializes in Pediatric Critical Care. Sep 24, 2016 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?IMeds mixed in a normal saline bag are kept in the original fluid bag, no?Exactly, they SHOULD be labeled. The discouragement of using pre-filled syringes is because that when somebody inevitably fails to label as they should, hopefully nobody will think "oh this is just saline".
iluvivt, BSN, RN 2,773 Posts Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience. Sep 24, 2016 There is another alert by ISMP that has more detail about the misuse of Saline prefills.I have it on my computer at work and will find it and post it.The IFUS for prefills state that the product is only be used for IV catheter flushing.It is a one time use as well.You can not use 5 ml...save it and cap it and then use the remaining 5 ml later.You need to use it and discard it and the cap that covers the end should not be used to cover IV tubing either.
blondy2061h, MSN, RN 1 Article; 4,094 Posts Specializes in Oncology. Has 15 years experience. Sep 25, 2016 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?IMeds mixed in a normal saline bag are kept in the original fluid bag, no?Right, I bring the flush, needle, and med on my COW to the bedside and do it there. If for some reason I'm not giving it immediately, I label it over the saline label on the syringe with what med I added. As far as inaccurate measurements, I only draw up in the saline syringe if I'm using the whole single dose vial, or if I'm drawing from a carpojet insert that has it's own measurements. Otherwise, I'll draw up with a smaller syringe- then inject into the saline syringe to dilute it. Also- I would never use a saline syringe that was already unwrapped by someone else. That's just bad practice.
iluvivt, BSN, RN 2,773 Posts Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience. Sep 25, 2016 It does matter though for more than one reason.The marking on the prefills are not in .2 increments and if you pull back the syringe too far you may be pulling back your mix onto an unsterile part of the syringe.I will find a reference that explains it in detail and find the alert by ISMP
iluvivt, BSN, RN 2,773 Posts Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience. Sep 25, 2016 It also violatesThe Joint Commision National Patient Safety goal 3D as the syringe is already labeled as to its contents.Manufacturers state this in their literature and and in their instructions for use.
iluvivt, BSN, RN 2,773 Posts Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience. Sep 25, 2016 I found a good and really entry ISMP document titled "ISMP Safe Practice Guidelines for Adult IV push Medications....see section 3.6 It's a PDF and I can't figure out how to post it..It explains that the NS prefills or any prefills such as Heparin can only be used to flush VADs.The FDA says NO for reconstitition,dilution or administration.Perhaps someone more tech savvy than I am can help here.
Anonymous865 483 Posts Sep 25, 2016 I found a good and really entry ISMP document titled "ISMP Safe Practice Guidelines for Adult IV push Medications....see section 3.6 It's a PDF and I can't figure out how to post it..It explains that the NS prefills or any prefills such as Heparin can only be used to flush VADs.The FDA says NO for reconstitition,dilution or administration.Perhaps someone more tech savvy than I am can help here.Here's the link to the PDF you referenced.Guidelines for Adult IV Push Medications. | AHRQ Patient Safety Network
Julius Seizure 1 Article; 2,282 Posts Specializes in Pediatric Critical Care. Sep 25, 2016 It does matter though for more than one reason.The marking on the prefills are not in .2 increments and if you pull back the syringe too far you may be pulling back your mix onto an unsterile part of the syringe.I will find a reference that explains it in detail and find the alert by ISMPThis is a good point. Additionally, once you squirt out the saline into a vial for reconstitution of a med, drawing it back up into the same syringe is technically a break in sterility, as the inside of the syringe is no longer sterile because the plunger has been pushed in, exposing the inside of the syringe to the outside.We used to (years ago) hook up versed bags to patients with a syringe in the middle (similar to an anesthesia set up for pushing blood or fluids) so that we could draw up from the bag and run the med on a syringe pump. We would use the same syringe repeatedly to draw up more med - till someone realized how unsterile and gross that was. Now, new syringes every time.
Julius Seizure 1 Article; 2,282 Posts Specializes in Pediatric Critical Care. Sep 25, 2016 Oops, nevermind, somebody already posted the link!
5alazar 2 Posts Sep 26, 2016 Sorry everyone for the lack of clarification.http://saljetrinse.com/images/fourvials.jpg^^^ these are similar to what I'm refering to when I mean NS flushes. We have to draw them up out of those first before administering them. So what we used to do is use a twist-locking syringe to lock onto that, withdraw the 10ml flush, take it off and administer.The new practice I'm asking about it is using a drawing-up needle to withdraw that.
smf0903 844 Posts Sep 26, 2016 5alazar said:Sorry everyone for the lack of clarification.http://saljetrinse.com/images/fourvials.jpg^^^ these are similar to what I'm refering to when I mean NS flushes. We have to draw them up out of those first before administering them.So what we used to do is use a twist-locking syringe to lock onto that, withdraw the 10ml flush, take it off and administer.The new practice I'm asking about it is using a drawing-up needle to withdraw that.We only use those for topical flushes and just twist the cap area off and squirt directly on the wound or whatever. I am really curious if anyone uses those for drawing up flushes because my understanding is that those are for topical use only.This is what we used for drawing up saline flushes, they are specifically used as a multidose for injections.
