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

[blondy2061h, MSN, 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.

Your patient needs a dose of IV lopressor, 5mg. Vials of it are stored in the Pyxis. You are not privileged to give this drug IV push. Therefore, you do what? You grab a 50ml Normal Saline bag and inject the drug in there and run it piggyback, of course labeling the bag (that comes from the manufacturer saying 0.9% Sodium Chloride) with the name of the drug you added to it. This is the exact same scenario that you're telling me is UNSAFE, and it happens daily in hospitals everywhere. Even my drugs that come premixed from pharmacy in piggyback bags come in bags that have 0.9% Sodium Chloride printed on the bag with the pharmacy label over it. It's no different if you have a bag that says 0.9% Sodium Chloride with another label specifying the drug added or a syringe.

[Aeterna, BSN, RN]

If I'm in a rush, I've used saline flushes to reconstitute drugs, but as soon as they are reconstituted, they go into a mini-bag to be piggybacked on an IV. For example, say I need to give a stat dose of IV Ceftriaxone for a febrile patient. I'd grab the vial from Pyxis, inject 10 mL of saline from a pre-filled syringe, let the medication dissolve, then draw it up in my syringe and inject it into a labelled mini-bag of NS. We never do IV pushes on the floor (except for very specific chemotherapy drugs that need to be pushed, and only if you are certified to do it) so there is never an instance where we would leave a medication diluted in a pre-filled syringe.

[eatmysoxRN, ASN, RN]

Your patient needs a dose of IV lopressor, 5mg. Vials of it are stored in the Pyxis. You are not privileged to give this drug IV push. Therefore, you do what? You grab a 50ml Normal Saline bag and inject the drug in there and run it piggyback, of course labeling the bag (that comes from the manufacturer saying 0.9% Sodium Chloride) with the name of the drug you added to it. This is the exact same scenario that you're telling me is UNSAFE, and it happens daily in hospitals everywhere. Even my drugs that come premixed from pharmacy in piggyback bags come in bags that have 0.9% Sodium Chloride printed on the bag with the pharmacy label over it. It's no different if you have a bag that says 0.9% Sodium Chloride with another label specifying the drug added or a syringe.

Why can't you give Lopressor IVP? My unit does all the time.

[blondy2061h, MSN, RN]

Why can't you give Lopressor IVP? My unit does all the time.

I just picked it as an example, but lopressor IVP is restricted to critical care nurses at my facility.

[brithoover]

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

I frequently use pre filled flushes to dilute morphine, dilaudid ect. I put a label on it just as I would if I were hanging a piggyback

[iluvivt, BSN, RN]

http://www.ismp.org/newsletters/nursing/Issues/NurseAdviseERR200702.pdf see page one and three

[FerRN]

You know what's funny about the prefilled saline syringes? I have now worked in two facilities where you cannot find a 10mL vial of saline anywhere. So basically the hospital encourages this use of the prefilled syringes. Cutting corners at its finest.

[BD-RN, BSN, RN]

I read the article, but it's not really convincing me it's unsafe. Yes, if the syringe remains unlabeled and leaves that RN's hands, a HUGE mistake could occur. Well, TWO things I was taught NEVER to do with ANY medication in a syringe in nursing school just occurred; first of all, the syringe remained unlabeled. Even if I draw up subq heparin I label the syringe. Second, once I draw up something it doesn't leave me. Also, I don't understand the part of the article about it being unsterile. It's saline, used in PIV and central lines. So if it's not sterile, then it's also not safe for use in a vein. That makes me question the articles accuracy.

As far as sterile water vs saline to reconstitute a drug; they are labeled for the proper diluent to use. SOme say saline, some say sterile water. Use common sense, use your six rights; READ your labels. If the above mistakes occur, it's due to a missed step in the nursing process, not because you used a saline flush.

[iluvivt, BSN, RN]

If the Institute for Safe Medical Practice says that it is a NO NO then I believe them. The NS prefills are labeled for use only as a flush and not to reconstitute any medication.

http://www.ismp.org/newsletters/nursing/Issues/NurseAdviseERR200702.pdf