I have trouble pulling up clear liquid into a syringe

[Futurenurse7321]

Hi all.

I just wanted to say, I signed up for this website because it has been a lifesaver for me getting through nursing school thus far.

I’m going into my junior year of a traditional 4-year BSN, and have only done fundamental work on peers and sim dummies.

I have always had a problem with this, and I am almost too afraid to ask because it’s embarrassing.

We did mock needle injections on skin pads and oranges, and I passed test out so I must have done alright, but I really struggle when filling a needle syringe with clear liquid. I have such a difficult time differentiating between what is air and what is liquid, and I feel it’s dangerous because I don’t want to be injecting my real patients with a bunch of air or less medication than what is needed because I can’t tell where the liquid starts and the air ends! On colored medications, I can do the skill perfectly and have no trouble at all. However, at the end of my semester last year, we had to do a SIM where we administered the flu vac to a “patient” (which was only a dummy, and we injected into a skin pad, not even the dummy itself) and due to it being an IM injection and the syringe being large, and it only being a 1.5 mL dose of clear liquid in a thick 10 mL syringe, I had a really difficult time filling the syringe, and ultimately just injected it into the skin pad, not truly confident if I was giving the right dose, so I didn’t hold up the rest of my group from meeting all the objectives of the sim. I know I could never do this on a real patient.

Could you PLEASE give me tips on how to differentiate the liquid from air and air bubbles, because it seems that no matter how many times I practice, I still have a very difficult time.

[Jory, MSN, APRN, CNM]

Well, first, 10 ml syringe is the wrong size, should have been a 3 ml.

You need to inject about 1 ml of air into the vial before tilting it up to withdraw the solution. This creates pressure that allows you to draw it out easier. Don't use more or the pressure will kick back on you.

Make SURE the needle is BELOW the fluid line. Tilt the vile and hold it up to the light so you can get the needle LOW in the vile over to the side...draw up as much of the solution as you can. There is always extra.

Then when you have drawn up your solution, before you remove the needle, tilt the vile and needle up...while you are removing the needle in one motion, draw back more air. Yes, you'll see bubbles in your syringe..tap them out.

Now...CHANGE your needle...you don't want to use the same needle that you used to pierce the vial on your patient.

After your needle has changed, eject the air and the extra amount of medication until you have the correct dose in your syringe.

See if you can get some bottles of sterile water to practice.

[Crash_Cart]

1 hour ago, Futurenurse7321 said:

I had a really difficult time filling the syringe

Gather your supplies - vial, syringe, alcohol pad, sharps container etc. and make sure you have adequate lighting. Lighting is very important to identify where the liquid is inside the vial as you are drawing it out of the inverted vial at eye level.

Perform hand hygiene and maintain asepsis at all times. If you have a lot of bubbles, you can push all the medication back into the vial. Draw it out again slowly and tap any air bubbles out. Double check that you have the right amount of medication drawn before giving it to the pt.

[GrumpyRN, NP]

All the information above is good and very useful but I am reading it as if you are having a visual problem.

Have you tried glasses? Perhaps a simple pair of reading glasses when drawing up medication can solve the problem.

[JKL33]

I also read this as a difficulty in differentiating what is liquid and what is air within the syringe. An optometrist might be able to help evaluate this?

It's really sad that they would have students practicing this with a 10 ml syringe, though.

[2BS Nurse, BSN]

It's all about practice, practice, practice! You can purchase some non-sterile syringes at your local Fleet Farm if you have one (intended for farm animals). Just practice with tap water.

[Workitinurfava, BSN, RN]

It can depend on the consistency of the liquid and the needle you are using, when it comes to the difficulty of it.

[Coffee Nurse, BSN, RN]

If you think your syringe is full of liquid, pull the needle out of the vial and pull the plunger back a little further. If you have liquid, you'll see an air bubble appear in the syringe. If the syringe is full of air, nothing will happen because you're just drawing in more air.

[CommunityRNBSN, BSN, RN]

On 8/9/2019 at 6:25 AM, GrumpyRN said:

All the information above is good and very useful but I am reading it as if you are having a visual problem.

Have you tried glasses? Perhaps a simple pair of reading glasses when drawing up medication can solve the problem.

This was my first thought as well! Has it been a while since you’ve had an eye exam? I am a new nurse and struggle with a lot of things— not least with getting medication to go into the darn needle— but I do not struggle to see whether a clear liquid has gone in or not.

Someone suggested getting sterile water to practice. I don’t even think you need it to be sterile water and a vial; just bring a needle home and practice with water from a cup. That way you can practice seeing what clear liquid looks like when it is in the syringe, vs. air in the syringe

[traumaRUs, MSN, APRN]

I second get your eyes checked.

[GSDlvrRN, MSN]

4 hours ago, Workitinurfava said:

It can depend on the consistency of the liquid and the needle you are using, when it comes to the difficulty of it.

Ever tried pulling lorazepam with a subq needle? I did that once when supplies were ridiculously low!! ???

[2BS Nurse, BSN]

In real practice, you may have access to these. If not, always draw up with an 18 G needle if you can. I know that some school programs have limited supples:

https://www.cardinalhealth.com/en/product-solutions/medical/patient-care/sharp-safety/needles-and-syringes/safety-needles-and-syringes/monoject-smart-tip-needleless-vial-access-cannula.html

I agree with having an eye exam if you haven't in a while.