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.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
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.
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?
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".
Specializes in Infusion Nursing, Home Health Infusion.
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.
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?
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.
Specializes in Infusion Nursing, Home Health Infusion.
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
Specializes in Infusion Nursing, Home Health Infusion.
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.
Specializes in Infusion Nursing, Home Health Infusion.
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.
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.
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
This 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.
^^^ 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.
TriciaJ, RN
4,328 Posts
That is good to know. I had no idea. Thank you.